HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
67 1, L R�C�VED
0 2021
Building Permit Application
Planning and Development ServicesPC ICounty
Building and Code Regulation Division Commercial Residential 07
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: G /e CJ F j a
Address: �JG ys��ti ��re I� T7. /1, I—L. 3L/ Lll
Property Tax ID #: I �j — 19 01177 — 0 0 V l Lot No._
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
o4lectric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ //90
(Affidavit required)
Windows/Doors
Sprinklers _ Generator _ Roof
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic BuildingHeight:
Name I v i r1; f
Address: 2c4n, L, + }-
City: i- Pi et- c. _ State: Zj
Zip Code: 3gjq. , Fax:
Phone No. 27 - 7 7 3 — 2, <4 5
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
City:
Zip Code:
Phone No
E-Mail
State or County Li
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.
Fax:
Pond
Pitch
State:
SIJPPLE(1lIENTAL CONSTRUU.CTION LIEN LAW IN(jORMATIOIV
'MORTGAGE
DESIGNER/ENGINEER: _ Not Applicable
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 Amendfnents.
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 Wmmencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF �;4X4'z
Swo n to (or affirnaand subscribed before me of Physical. Presence or Online Notarization
this day of 20..a by
Name of person making statement.
Personally Known OR P uc d Identification
Type of Id e tification Produced .'
,
(Signature of Notary P lic- State of Florida )
Commission No. (Seal) AUDREYB.HUMPHREY
Q. MY COMMISSION # GG 300817
6, 2023
EXPIRES: March
Bonded Thru Notary Public Undef\V(AC 5
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