HomeMy WebLinkAboutYoung-2020 SLC Building PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
21r.fLUCES -1,
0
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
Lot No.
Block No.
Additional work to be performed under this permit— check all that apply:
—Mechanical — Gas Tank —Gas Piping Shutters Windows/Doors Pond
— Electric — Plumbing — Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Name
Address:
City: State•
Zip Code• Fax:
Phone No.
E-Mail:
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address•
City: State:
Zip Code• Fax•
Phone No
E-Mail
State or County License
If 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.
ON`yA3w i£ "�A' g;:i,. g *. *"%' "Y °' "#. --'r
ona �»:
DESIGNER�ENGiNEER: � Not Applicable
MORTGAGE�COMPANY:
_Not Applicable
Name:
Name•
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: 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 County Amendments.
accessory structures, swimming pools, fences, walls, signs, screen roams and accessory
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvem our property. A Notice of Commencement must be recorded in the public records of St.
Lucie C unty and po ted on the jobsi beferet re -first inspg . ltyou intend to obtain fi ng, consult
with Ipn r nn nrnpv hpf commencing work or rjL6orcline voub Notice of CbrNmencement.
Signa ure of Owner/ Lessee/Contractor as Agent for Owner
(Signatuj591-Can#aetcrr10cense Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF ` . i iC x
COUNTY OF U e
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Sworn to (or affirmed) and subscribed before me of
S% to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this —71 ay of 2024 by
this ay of , 2024 by
Name of person m g statement.
Name of person ma � sstatement.
Personally Known OR Produced Ide
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Personally Known Produced Identification
Type of Identification
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Type of Identification
Pr aced
Produced
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(Signature of Nota y Public- State of Florida)
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