HomeMy WebLinkAboutBuilding Permit Applicationti
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: �� l/
91ro
-- _x.- Building Permit Application oepa�Y�e�t
Planning and Development Ser vices
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
per St t�ucie Cou
Residential
Property Tax ID #: y 06 fi j'D Od Lot No._
Site Plan Name: Block No.
Project Name:
r
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply-
-Mechanical _ Gas Tank —Gas Piping _ Shutters O" Windows/Doors _ Pond
_ Electric _ Plumbing —Sprinklers _ Generator ✓ Roof Pitch
Total Sq. Ft of Construction: 0 Sq. Ft. of First Floor: `Zv
o"st of Constructionr$� (�f1 c7. o o Utilities: _ Sewer _ Septic Building Height:
OWNER/
RACTOR.
Name JW
Name:
Address: 4 11c)
Company: .
City: f (p 4 r c G ;. State: _
Zip Code: Fax:
Phone No. :77 Z - b7 2 - Z 711'
Address:
City,:State:
Zip;Code: Fax:
Phone.No
E-Mail: Z 12 96(—
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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.
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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.
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 accessory uses to 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 attornev before commencing work or recordiniz vour Notice of Commencement.
X
ignature'ofWOwner/ essee/Contra or as Agent for Owner
,`
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 54:: L,U C, C
COUNTY OF
Swor o (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this Z l day of IND1,L 2021 by
this day of 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification `"`
Type of Identification
Produced 7t� - �;
Produced
(Signature of Notary Public- tate of Florida )' 0
(Signature of Notary Public- State of Florida )
o
Commission No. (Sea �3 o >
Commission No. (Seal)
c3r_°oFri
REVIEWS
FRONT
ZONING
39'PI R
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
NLiV/
REVIEW.
REVIEW. -
REVIEW
REVIEW
DATE
.°;` 0
RECEIVED
m 70
DATE
COMPLETED
Rev. 5/b/ZU