HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 22
Date: Permit Number:
RECEIVED
" LLB JUN 14 :2021
Building Permit Application Permitting Department
St. Lucie County
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:
PROPOSED IMPROVEMENT LOCATIQN
_....a
Address: '17W19 salarb
Property Tax ID#: Q 1 _ v -1 go 0'J Lot No.
Site Plan Name- / Block No.
Project Name: l2
DETAILED DES�RIPTIQN OF WQRK
6DI'?
New Electrical Meter Second Electrical Meter (Affidavit required)
CO,NSTR,UCTIaN INFORMATIC►N
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:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE CQNTRACTQR
Name rylafkylG ;.; Name:
is
Address: 7406 Company
City: '�State,i�?• Address
Zip Code: ,` I Fax: - _.~_. City: State:
Phone No. Zip Code: �34/ Fax:
E-Mail: M COM Phone No '719 6&1 - 416041
Fill in fee simple Titl Holder on next page (if different E-Mail • CUYY!
from the Owner listed above) State or County Lice se
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.
Sl1PPLEiVfENTAL CONSTRUCTION LIEN LAW INFORMATION
/ n . , MORTGAGE COMPANY: N:
DESIGNER ENGINEER: _Not Applicable of 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 o d on the jobsite before the first inspection. If you intend to obtain financing, consult
with le d r or n t me fore commencingwork or recordingour Notice of Commencement.
Xgature of Ow er/ essee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to(or aff' ed) and subscribed befo e me of \ Physical Presence or Online Notarization
this%C) day o 20 by
i
Name of person making statement.
Perso ally Known OR Produced Identification
Type f dentification Produced
(Sign ure Notary Public-State of FI a )
Commission No. (Seal) {IgAINGRAM4WWNG
MY COMMISSFON.#GG 275NO
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REVIEWS FRONT ZONING- SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
COMPLETED
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