HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 �• � � Permit Number:
Li T.�.CsC 0 v RECEIVED
Building Permit Application JUL 1 4 �2021
Planning and Development Services Permittin�Department
Building and Code Regulation Division Commercial Residential S uGe County
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: 1� rC.�,t �>�� G�'`G►n�
Address: �l ` U1/�
Lot No.
Site Plan Name: Block No.
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Project Name: �� ,-I\
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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
v""Electric —Plumbing —Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ r a� Utilities: Sewer —Septic Building Height:
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:Name e r Name: b l�Ci.ts(it,
Address: ,4i Company: Md V 5b k��d111
City: , �` pt� -� , State: X Address: KJ cc,vl , it L )"Al kv
Zip Code: Fax: City: 15r_'� f-- L'1C1 tr Stater
Phone No. Zip Code: �`C-f Fax:
E-Mail:��" 9M II,ig aq /,c1
�Z.c 0 1Min Phone No TZ j <6
Fill in fee simple Title Holder on next page(if different E-Mail s V r_t? yl/Ir1J 5e 7
from the owner listed above) State or County Licenses&i!26 15-5 6 D
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
wV h lender or an attorney before commencing work or recording our Notice of Commencement.
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Signature of Ow r Lessee/Contractor as Ag t for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to(or affir )and subscribed before me of `Physical Presence or Online Notarization
this day o 2q:�q by
; ti A, I e r r o D.S.
Name of person making statement.
Personally Known OR Pro c entificati n /
Type of Identification Produced !_g (�
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(Signature of No ary Public-St4L of Florida) v.
REY�
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Commission No. (Seal) :=o:N,4pu
EXP1RESt :,rxiters 13
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Bonded ThNNotary'
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2 21