HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4 -7-e2 I Permit Number: .20 (0 • � I ��
§1_CL
, ` LC E.L RECEIVED
JUN 0 7 2021
Building Permit Application Permitting Department
Planning and Development Services
St.Lucie County
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: 4A,— D N
PROPOSED IMPRQVEMEIVT LC}CA71QN x a
F �.
Address:�/�24� /�ew j,�:rj X D �jtk A�T �z/L y7 7
Property Tax ID#: � ) �� Q Q� c o ® ` Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION 01F,WORK
New Electrical Meter Second Electrical Meter (Affidavit required)
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CONSTRUCTIC►N INFORMATION
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: Sq. Ft.-of First Floor:
Do
Cost of Construction:$_ � - Utilities:" _Sewer ' _Septic' Building Height:
OWNER/LESSEE
�..,. . �
Name nth%�� '`� &0/Y Name:
Address:/,? Company:
/?
City: &r �i�'✓L state: L.. ;,.Address:
Zip Code: 3(-lei 4 Fax:e� City: State:
Phone No. 7'202-2e,0 - Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) 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.
SUPPLEMENTAL CQNSTFi )CM L[EN LAIN IN ORMATIOfU
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.
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 lend or an attorneybefore commencingwork or recordingour Notice of Commencement.
Signa ure of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA 4
COUNTY OF
Sworn (or affir and sub cribed before me of Physical Presence or Online Notarization
this day of 20.04 by
Name of perso a ing statement.
Personally Known OR Pro d Identifi ration
Type of Identification Produced P
(Signa ure of Notar ublic-State of-rTorida )
.S�pY PU AUDREY B.HUMPHREY
Commission No. (Seal) '° '"¢: MYCOMMISSION�t:GG3$0817
EXPIRES:March 6,2023
A.
OF F;°c' Donded'fhN Notary Public Unden+►11ers
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
�ev /20/21