HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION O BE ACCEPTED �10
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Date:
�• ���� Permit Number: �V(
9M,L ! .Q 1�' RECEIVED
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Building Permit Application .
St.Luoie County
Planning and Development Services Permittl g
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 349$2
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED 1NIPROVEMENT LdCATION
Address: OATSL c IL F13
Property lax ID#: 0 0- Lot No. 21
Site Plan Name: �1 - Block No. �
Project Name: ( I��AK� WWT-�: At 4 `p L b i'7-l
DETAILED DESCRIPTION OF
511,9. A pal
J�
ee
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTR,UCTIQN INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _7_R0
ows/Doors Pond
Electric _Plumbing _Sprinklers _Generator of Pitch
Total Sq. Ft of Construction: . U Sq. Ft.of First Floor:
Cost of Construction:$� J (�(7 . Utilities: —Sewer —Septic Building,Height:
OWNER/LESSEE CONTRACTOR: .
Name Name:
Addr�ss: I Company: f,
City: 6 Caft.UCLA State: Address:
Zip Code: Fax: _ City: State: L
Phone No. Zip Code: L•t��`7 Fax:
E-Mail;FLOII �5 OBI Phone No
Fill in fee simple Title Holder on next page(if different E-Mail S• ON
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$7A00 or more,a RECORDED Notice of Commencement is requiied.'
SUPPLEMENTAL CONSTRUCTION l_LEN LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: A Name:
Address: M Address:
City: NJState: City: .State:
Zip: Phone Zip: h
FEE SIMPLE&LE' HOLDkR- N t Ap licable BONDING O AN : I ,Not Applicable
Name Name:
Addr ss: Address:
City: o City:
Zip: Phone: Zip: Phdne:
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.
ignature of O r/L cont ctor as Agent for Owner
STATE OF FLORIDA G�
COUNTY OF
),0/_��
Swo n to(or affi ed) d subscribed b me of ✓ Physical Presence or Online Notarization
this IT day of 2 ]by
Name of person making statement:
Personally Known OR Prodticed I ntification
Type of Identifi tion P dueed
(Signature of Notary Nblic-State o lotida)
Commission No. . eaIAREN S. NIELSEN
state of Florida-Notary Public
•= Commission # GG 207484
:
My Commission Expiresac '
June 12, 2022
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