HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
LFC�II
Building Permit Application AUG 9 2921.
Planning and Development ServicesI�
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax; R .2) 462-1578
PERMITAPPLICATION FOR: ����� (�G/11�e72' 5
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
Lot No. l
Block No. --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 _ Generator — Roof Pitch
Total Sq. Ft of Construction: �/ /�T Sq. Ft. of First Floor:,
oso struction: $ /�o' D� Utilities: _ Sewer _Septic Building Height:
Name1;[4 LK /S / / C1i IYAAV/0
Address: S ASW �,4AZCJ r S AU�''
City: V D rz7- S% AVM State:
Zip Code: 3Fax:
Phone No.
E-Mail: i' ':
- s �
Fill in fee simple Title Holder or11 Text page ( if different
from the Owner listed above)
ivame: iGcA•_
Company: ��s %i <
Address: J31 �'���.a�a/ ✓�
City: i�� ��, 1,ce Statel��
Zip Code: m4T Fax:
'Phone No 2 OL � LIn?
E-Mail G�C9?' a ��` —
State or County License 6c
If value of construction is 2500 or more, a RELUKUtU Notice 01 i 4uucu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
hw l(o I) 3K
DESIGNER/ENGINEER: — Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: a State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: — 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
witWTFder or an_.attgLrneV before commencing work or recording our Notice of Commencement.
Sig6 rurOw er/ " s /Contractor as Agent for Owner
FLORI
COUNTY OF
Sworn to (or affir ed) and subscribed before me of � Physical Presence or Online Notarization
this � day of �' 20&k by
Name of person king statement.
`
Personally Known OR Produced Identification
Typ Identification Produced
( o Notary P b 'c- State of Florida )
D
Commission No.c L ( al'a�a;, AMY:#GG
?° • ��': Notary Public of Florida
o; Commissio301816�roFF,
My Comm. Epr 1, 2023Bonded
through Naotary Assn.
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Rev 2 21