HomeMy WebLinkAboutBuilding Permit Application DECEIVED
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: AUG 112021 Permit Number: `7_CJ
(�;J�;I,Lude County
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Building Permit Application
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: �V
Lot No.
Site Plan Name: Block No.
Project Name:
Eva
New Electrical Meter Second Electrical Meter (Affidavit required) r.
_ 1
Additional work to be performed under this permit—check all that apply:.
_Mechanical _Gas Tank —Gas Piping _Shutters Windows/Doors `Pond
Electric _Plumbing —Sprinklers i Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Constructions$ � Utilities: _Sewer Septic ?Building Height;
Name Name: - -
Address: Company:
City: 1 State: Address:
Zip Code: Fax: City: State:
Phone No.. '2 q 9 -7VL/ R Zip Code: Fax:
E-Mail: yj l"A 9 �,u y1 6 JJ1,'A4ma. • �•\ 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.
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: 1
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.bu'ild 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 Cou ty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with le der r an attorney before commencing work or recording our Notice of Commencement.
/J
Signature o Owner Lessee/Contractor as Agent for Owner
STATE OF FL RIDA
COUNTY OF
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this t (day of 20 4fby
Name of person making statement.
Personally Known OR Produced Identification
Type of Id tification Produced
(Signature of No 3ryJa�y J,ic-StatEnfEFMq UGHN
;State of Florida-Notary Public
Commission No. Commissio(SgQG 270079
y Commission Expires
October-22-2.022._____� .
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DATE
RECEIVED
DATE
COMPLETED
Rev 5 2 21