HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �( _
Date: Permit N.umber:�1
91aF-Luag E
RECEIVED
Building Permit Application AUG 10 2021
Planning and Development Services
St. cie my
Building and Code Regulation Division Commercial Residential �ttinq
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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Address)
.Property Tax ID#: 3�c� �' Le I0 Q Z?� - 0W Lot No.
Site Plan Name: Block No.
Project Name:
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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
_Electric IL12lumbing _Sprinklers _Generator _Roof' Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ Q� Utilities: _Sewer _Septic Building Height:
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Name 1 -
Address: � Company:
City: mot— n C� State: Address:
Zip Code: 3�� (a Fax: City:;- State:
Phone No. �S "I Zip Code: Fax:
E-Mail: % f-yoa Phone No
Fill in fee simple Title Holder on next Page ( if different E-Mail
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$7,500 or more,a RECORDED Notice of Commencement is required.
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_ �
DESIGfiIER/ENGIfiIEER: 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: XNot 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
wi nder or an attorney before commencing work or recording our Notice of Commencement.
,�4' "41 —
Signature of Owner/Lessee/Contractor as g or Owner
STATE OF FLORf A n
COUNTY OF CIS
Sworn to(or affire�)sand subscribed befor me of _Physical Presence or Online Notarization
this L day of_I'�1t1� 20a�by
Name of person making statement.
Personally Known OR Prod Identification
Type of Identification Produced l..
(Signature of Notary Public-State of Florida)
K S. NIELSEN
Commission No. rPO��,State of Florida-Notary Public
_• R_ commission # GG 207484
My'"O'F%`11 c June 1121 ssion Expires
2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev 5 20 21