HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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Planning and Development Services
Permit Number:
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RECEIVED
Building Permit Application JU�3 2021
Ca
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Permitting , 1W
Residential 154—
Address: f �:O<-
Property Tax ID #:. fz2 ' ^ E3ti,3D,::�1 !3 "00c::, - f Lot No.
Site Plan Name:
Project Name:
Block No.
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New Electrical Meter Second Electrical Meter
(Affidavit required)
Additional work to be performed under this permit- check all that apply:
,4,M/echanical _ 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: $ d Utilities:- —Sewer _Septic—, Building Height:
..
N a m eSz� �0,4 �rk J ✓VJZ,L!<i
Name - _
Address: (ZU S cOM15,- C/a-
Company:
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City: State: IqAddress
Zip Code: g 5f B 2 Fax:
Phone No.& 7 21 Z:Mt�!` 15 /
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City: r:i-- �� tc .f Stater
Zip Code:30-.9 Z Fax:
Phone No (7?2]'Y99 -4YY,5R e(
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MailT4; �_
State or County Licensee 5 C 7.3 0
If value of construction is 2500 or more, a RELUKUtu Notice of Commencement 15 requlicu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ NotrcApplicable 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 that
or and covenants 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.
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Signa r of Owner/ Lessee/Contractor as g wner
STATE OF FLORIDA
A.
COUNTY OF
SworQt^o (or affir ) and bef -me
sub cribed re of Physical Presence or Online Notarization
thisZr11 day of 2Q by
Name of person making statement.
Personally Known OR Pr d Identif•c tion
Type Identification
of Produced
(Signature of Notary Pu li - State of F orida )
Commission No. (Seal) AYVzi• , AUDREYB.HUMPHREY
iote;....e4o
COMMISSION # GG 300817
m'•KMY
EXPIRES: March 6, 2023
e ' Public Underwriters
0ondcd ThN Notary
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ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
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DATE
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DATE
COMPLETED
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