HomeMy WebLinkAboutBuilding Permit ApplicationII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
91r. , RECEIVED
0 JUN 0 3 2021
Building Permit Application
ST. Lucie County, Permitting
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 LOCATION:
0�
Address: �_ ;� n
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED 'DESCRIP.TION OF WORK:
r
fir. Dccl�
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ ,303 j ?�
AWindows/Doors
_ Roof
Sq. Ft. of First Floor:
Lot No.
Block No.
Utilities: —Sewer _Septic Building Height:
Pond
Pitch
OWNER/LESSEE—CONTRACTOR.,
Name lSciS d �"no"'r '9A� t�
Name: /e
Address,S�
Company L'/'--
City: Ll��� F State: _
Address:
Zip Codel2�� Fax:
City: ��si` State: L
Phone No.
Zip Code: 3110Fax:
E-Mail:
Phone No i- Q/-6960
Fill in fee simple Title Holder on next page ( if different
E-Mail Xle
from the Owner listed above)
State or County License ey—mf
13 a-4
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.
SUPP�L` EfUIENTAL CQNSTRU3CTI�ON LI;EN�LAW 1NFORaM, TO '�'
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 1 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
44-6 lonrlo ^r nn n4+r%rnmw hnfnra rnmmanrina Wnrk nr rPrnrdino vnur Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of C ractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this day of , 2020 by
this day of , 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produce
gaje���
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Flori Hannah De Ru
NOTARY PUBLI
Commission No. (Seal)
Commission No. I) STATE OF FLO
i Comm* GG241
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DATE
RECEIVED
DATE
COMPLETED
Rev. 5/ b/ [U