HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (/{'� Permit Number: NW—Ga4rA
SIT,-. ` r`� �L L RECEIVE®
ro 1 �f JUN
Building Permit Application St.Lucie County
Planning and Development Services `Permitting
Building and Code Regulation Division Commercial Residential 1c
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: �Ov �' (ow to �GCQrnQ��
', PROPQSED IMPROVEMENT,LOCATIQN =
Address:
�
S� D v i v 3 Sor � pr e
Property Tax ID#: 3�6L �(� o? o� I Lot No. !
7 L- /I
Site Plan Name: �YIG1IQ/� ll �t' �islL gLGS (/Rl�(�' 41 Block No.
Project Name:
DETAILED DESCRI .T,ON,QF WORK
1�mdim AoWff 5h14 0 v .ei 0 Me A�
New Electrical Meter Second E ectrical Meter (Affidavit required)
CONSTRUCTIC►N INFORMATIONwol
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 X Roof L 2 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: AP 34P
rr
Cost of Construction: 01 Svo Utilities: _Sewer _Septic Av Building Height: L' v
DINNER%LESSEE ;r CONTRACTOR
Name U?T Name: Q l.✓Yl�
Address: ;- 6 3 D/U Or/ve Company:
City: rlv-4 A(W State: Address:
Zip Code: '3 y y K7_ Fax: City: State:
Phone No. 7 — s Zip Code: Fax:
E-Mail': L d (&J Phone No
Fill in fees ple Title Holder on next iVage ( 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.
SU.PPLE11/IENTAL CQNSTRUCTION LIEN LAW IIVFORNiAT101V e T
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 lender or an attorney before commencing work or recording our Notice of Commencement.
Signat e of Owner/1-6/see/Contractor as Agent for Owner
ST E OF FLORIDA
CO .NTYOF �k ,
Sworn to(or affirmed) and subscribed before me of Physical Presence or Online Notarization
this 4N day of'S Qyyr1 20k% by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
°
(Signature of Notary Public-State of Florida )
DEANNA GIVENS
Commission No. °4':
n. Not��l�lic-State of�;orida
al Commission#HH 08b359
'` My Comm.Expires Jan 28.2025
Banded through National Notary Assn.
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