HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED. V _. J /► .�
Date: Le -z.•S' a� Permit Number: 1—+J
RECEIVED.
O �- '• Building Permit Application JUN 2 5 2021
Planning and Development Services St. Lucie, unty.
Per in�a
Building and Code Regulation.Division C0171meYCial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4624553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 5JO5 &edyit n��✓t
PropertyTax ID #: 60)_Onff-coo Lot N6,R3323y
Site Plan Name: Block -No.— .
Project Name: 6tiL-3 r,«r-f r
New Electrical Meter Second Electrical Meter (Affidavit required)
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: Sq. Ft. of First Floor:
Cost of Construction: $ bOC� Utilities: —Sewer Septic Building Height:
0111/:NER/LESSEE:
C®NTR,ACOT R:
Name r�✓�S �s. /�rJ/in., Gz�s
Name:
Address: 5/05 #06 rekrc . Wl-c '.
Company: .
City: � State: �L
y i o /7" �"J rret
. . .
Address:
Zip Code: Fax:.
City: State:
Phone No.
Zip Code; Fax:
Phone No
E-Mail: &VIS .
Fill ,in fee simple Title Holder on next page ( if different
E_.
from the.Owner listed above)-
Mail .
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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:SUPPLEMENTAL�CO.NSTRIJCTI®N LIEKN LAUU INFO.RIVIATI®N,-
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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
is in Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which conflict with any applicable
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,
conso with lender or an attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 5'C. L Ltc--% c-
Sworn to (or affirmed) and subscribed before me of ✓ Physical Presence or Online Notarization
this ZS day of Smaxe— 20 Al by
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification Produced
(Signs ure of Notary Public -State of Florida) JOHN SCHERER
P�Bii,
° `�-Notary Public -State of Florida
Commission No. %J� / (Seal) Commission # HH 69519
°*
;��a��°�, My Commission Expires
December 06, 2024
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