HomeMy WebLinkAboutBuilding permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ` /+�
Date: � Permit (Number: �� V
RECEIVED
Building pp Permit A lication SEP 1 0,2020
Planning and Development Services Permitting DVeRartment
St. Lucie Wounty
Building and Code Regulation Division Commercial I Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
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PERMIT APPLICATION FOR:
P`ROPOSED"IMPRQVEMENT YLOCATION. 2
.
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters i Windows/Doors _ Pond
Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: 1400 Sq. Ft. of First Floon // Cw
Cost of Construction: $ 7S, Utilities: _ Sewer _ Sleptic Building Height:
OWNER/LES EE.
CONTRACTOR:
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City/AW—State:
Name:
Company:
Address
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Zip Code Fax:
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Phone No. _
E-Mail: CifCjt^�
Zip Code.-
Phone No �� ��'
Fax:
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
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it value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. ,
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St1PFLEMENTAL CONST SUC` 15 1 LIEN °LAW 1NFORNIATION � X 7� � 4
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: I State:
Zip: Phone
Zip: i Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: i Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit. ,
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie CountyAmendments.
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The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessoryusesto another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
gnature Owner/ essee/Contractor as Agent for Owner
Sig ure of Contractor/License Holder
STATE OF FLORIDA II
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STATE OF FLORIDA
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COUNTY OF • L�,i(' Ir2
COUNTY OF i C+- • AC K-
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
L,115hysical Presence or Online Notarization
P�h,y!sical Presence or Online Notarization
this �l�iay of 2020 by
this jv'ylday of2020 by
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Name of person making statement.
Name of person making statement.
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Personal) Known OR Pro uc enti
Y �HI�t9PJA IESALT
sP rsonally Known � OR Produced Identification��
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Type of Identification "" �'�nYCOMMISSION#GG270
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GF pe of Identification
Produced E)V Ta Z U EXPIRES:OCT23, 202
Pr duced 9%L-Dl. IT 2 �� W4 0
� Bonded through 1st State Insu
ance
(Signature of Notary Public- State of Florida)
(Signature of Notary'Public- Sta 2 ., it TINA MARIE SALTOS
COMMISSION
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Commission No. (Seal)
#GG270307
EXPI ES: OCT 23, 2022
Commission b3l)� ��►
No. Bbh�ough 1st State Insurance
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