HomeMy WebLinkAboutBuilding Permit ApplicationAIIAPP88PLETE��0���9L������08E4��EPTG0
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i Date: / Penn�Nunnber
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'RECEIVED
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Address:
Property Tax 0#:
site Plan NameProject Name:
:
FAILED
New Electrical Meter Second Electrical Meter-
Lot No.
Block No.
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Additional work tobeperformed underthispennit—checkaUthatoppkc
—Mechanical GasTank __ Gas Piping Shutters Windows/Doors Pond
l XE|ectric Plumbing __Sprinklers Generator Roof Pitch
Total Sq. Ft. ofFirst Floor:
CostofConstruction: $ W 96 6. cc Utilities: —Sewer —Septic Building Height:
Co
Fill in fee simple Title Holder on next page (if different
E-Mailtn�kE C'02�_
from the Owner listed above)
State or County License,&�d 1-goo. 5 85q
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Rvalue mfHAVC is $7,5QDormore, aRECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LI�EN�LAWsINFORMATl0111
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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.
ISt. 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.
Iln consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
din 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 po the jobsite before the first inspection. If you inte obtain financing, consult
with nder or an atifornevbefore commencing work or recording our Noti a of Ctimmencement.
Sig u of Owner/ L s e/ ontractor as Agent for Owner Sigfidrg of Contract- ense Holder
STATE OF FLORIDA / STATE OF FLORIDA'�_)J
COUNTY OF�� �CL'lC COUNTY OF t-Zl
Sworpto (or affirmed) and subscribed before me of Swo to (or affirmed) and subscribed before me of
(/Physical Presence or Online Notarization V Physical Presence or Online Notarization
! this day of , 2020 by this day of , 2020 by
/A ��L� /��2W�
Name of person making statement. Name of person making statement.
Personally Known v OR Produced Identification
Type of Identification
Produce %�Alt�
A,41-- vi l
(Signature of Notary Public- State of Florida )
Commission No. Co /
DeAnn A. Prue
NOTARY PUB!
STATE OF FL(
Personally Known v OR Produced Identification
Type of Identification
Produced w / n
kW✓r ( L L" (e-
(Signature of Notary Public- State of Florida )
on No. �I `O e oZ DeAnn A. Prue
' a� NOTARY PUBI
--STATE OF FL(
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