HomeMy WebLinkAboutBUILDING PERMIT APPLICATION��iv,
All APPLICABLE INFO MUST BE COMPLEfED FOR APPLICATION TO BE ACCEPTED ~ � D
Date: 30 - o^tc)a I Permit Number: a o20oZd % .(p
RECEIVED
p JUL 0 9 2021
p �a r� Building Permit Application Permitting Department
st. Lucie county
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:
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PROPO- SEO IMPROVEMENT LOCATION:
Address: .Sbag- Erw%-erSon r-)v-c
Property Tax ID #: I C) I 'c-1 S^&, �,S' 60nn Lot No._
Site Plan Name: (;.cqrcQe Block No.
Project Name:
OETAILED DESCRIPTION OF WORK: "
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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
(Affidavit required)
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:)
Cost of Construction: $ / fl , .� �•
Sq. Ft. of First Floor:
Windows ,(D_oprs _Pond
1-0"Roof itch
Utilities: —Sewer —Septic Building Height:
OWNER%LES'SEE: "..
CONTRACTOR:
Name Tttrrnrsl Ntc,��
Name:
Address: $�.5 ?'tn S'i-
Company:
City: State: '��.
Zip Code: 3�9RCa a Fax:
Phone No.'7'7a--e1nq -0$bO
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on.next page ( if differen
from the Owner listed above)
E-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.
SU,PP,LE,MENTAL CONSTRUCTION LIEN ,LAW INFORMATIOW
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: ✓4ot Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _/Not Applicable
Name:
BONDING COMPANY: _ of Applicable
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 subjectstructure
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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of V Physical Presence or Online Notarization
this day of , 20�91 by
rt' ivw�c3�lnu �r��
Name of person making statement.
Personally Known +/OR Produced Identification
Type of Identification Produced
(Signature of Notary P lic- State of Florida
Commission -No. 4 4 C-S(13 (,Q(Seal)
Apr
Notary Public State of Florida
Michelle L Jurkiewicz
MYComa 0113�2
or4d� Expires06/16%12024
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