HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:, /�� 2 I Permit 4 er: a•,tO�'' . Qa rj`�
tt 1VE
L ricn S - RECEIVED
. f `� JUL
0.7 2021
JUL 02 2021
Buildinggrty
Permit pp St.Lucie County
Planning and Development Services Permitting
Building and Code Regulation Division CC+i t-hei"Cial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
Address: e�)g -
Property Tax ID#: ���O ��J—d�q5- t�aV a Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required)
.^.r- r l S.t.. v v "4'�t •`t� �" t sr �' y 5� e �-t e r s 2-:'s � ss �' r La. t�. �....
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:_ 9r 3 -Z�]7 Sq. Ft. of First Floor:
Cost of Construction: $ f/�. Utilities: Sewer _Septic" Building Height:
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Name :. ? Name:o�w .f/� J` �
Address:_7& �/y��r iL9'� Q P.t'L'l9C Company:
City , f / -�, ;�'�,,,,°� _ry.` Ly,State: � UO .� e-
-. .' Address: Car
Zip Code: /!�$�:I' :Fax: 3 '�',�• :/-''�
City: ���G'tr
", - -•-- y-_ � State
22
Phone IVo.c7"< Zip Cody/G$�/
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E-Mail: �, f/ Phone No — t
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Fill in fee sirrmple`Title Holder on next page( if different E-Mail G,Zx (�i�
from the Owner listed above) State or County License
r
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.
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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 priorto 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 j.obsite 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.
�inAum of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIJ A
COUNTY OF k-
Swop to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this d- day of n 1 20dX by
Name of person making statement. ,
Personally Known _ OR Produced Identification
Type of Identification Produced' L.
(Signature of Notary Pu ic-State of Florida )
Commission No.WA0LCWk (Seal)
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