HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U / Permit Number: ) o 7-��. ,
RECEIVED
0 9 2021
Building Permit Application
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Plannin and Development Services Permitting COunt'
9 P St.Lucie Count
Building and Code Regulation Division Commercial Residential }C
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 5l�ly ���Gt/'y7e9-� er4' �.erceZ A�9_157f
Property Tax ID#: LW '50-o00-,3 Lot No.
Site Plan Name: Block No. /JAY
Project Name: "a- are
fa 441-- 777&z %L
New Electrical Meter Second Electrical Meter (Affidavit required)
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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: OX, Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
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Name ,3 Name:
Address: ✓- '�/ c- � -e
pi`>� Company:
City: o Gp State Address:
Zip Code: 349!517 Fax: City: State:
Phone No. 77,c?, Yd? 9q0539 Zip Code: Fax:
E-Mail: ram. 'l e� �UQ�.00. Goft- Phone No
Fill in fee simple Title Holder on next page (if different E-Mail _
from the Owner listed above) State or County License
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 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 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 re of Owner/Lessee/Contractor ag Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swor o(or affirmA and subscribed before me of Physical Presence or Online Notarization
this day of 20, by
o P- 17r ) s
Name of person making statement.
Personally Known OR Produced Identification ` (i
Type of Identification Produced
0"Aw
(Signature of Notary Public-StaVe of Florida)
Commission No. (Seal) ;oiPYNy AUDREY B.HUMPHREY
1,!y Ct?MMISSION#GG 300817
'-_sjz�yQo F_XPIRES:March 6,2023
:FOF ry4 :'i7vu Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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DATE
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