HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a's - ' Permit Number:
RECEIVED
Building Permit Application JUN 2 5 2021
Lucie County
Planning and Development Services St. Pen i 'ng
Building and Code Regulation Division Commercial Residential
2300 Virainia Avenue, Fort Pierce FL 34982
Address: Zfq 5I0 F:::6,y-T k e rce PL- 3+w-k
Property Tax ID #: I T-gyp
! IS — Do i �j' =Q Lot No.
Site Plan Name: r
Project Name:
2q2
N
w;ym Y/5 H s it
Second Electrical Meter
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a51JI>>n X6.5-
Additional work to be performed under this permit —check all that apply:
—Mechanical _ Gas Tank —Gas Piping — Shutters
_ Electric _ Plumbing — Sprinklers
Total Sq. Ft of Construction: L11 3 20
A `s-'
_ Generator
�26.
N
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
_ Roof Pitch
Cost of Construction: $ 3 Sib X Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE' ',
CONTRACT'OR
Name n5 �/Y O
Name:
Address: "5V
Company:
City: -g yq-- Pi',e State:
Address:
Zip Code: ';L1(qS i Fax:
City: State:
Phone No. 9q1-- 35b —4fSq- -
Zip Code: Fax:
E-Mail:F/1-I° %7"rooe, i)'1' ilc colo
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License
2
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN lNFORMATIQN
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 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 attornev before commencine work or recordine vour Notice of Commencement.
OR
of Owner essee/Contractor as Agent for Owner I Signature of Contractor/License Holder
(S�ATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF \ • �il t�_� Ir. COUNTY OF
Sworn to (or affirmed) and subscribed before me of
✓✓ sical Pres nce or Online Notarization
this day of 2024 by
�:—ev,we J wed
Name of person making statement. /
Personally Known OR Produced Identification ✓/
Type of Identific i
Produced_ 2 I 1
re of Nbfary P
Commission No.
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
KAREN S. NIELSEN
;Stat(S@(a�lorida Notary Public ommission No.
Cpmmission # GG 207484
My Commission Expires
(Seal)
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