HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u 2
Date: Permit Number: -od 1 -
� ff D r���_ RECEIVED
���`� O �> AUG 13 2021
Building Permit Application
St.Lucie Cwnty
Planning and Development Services Permitting /
Building and Code Regulation Division Commercial Residentialv/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
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PERMIT APPLICATION FOR:
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Address: 3v05 �N t-.►'bl°�3L26_W ILL, 00XJ-_ -
Property Tax ID#: r--L�0 .— (p Lot No.
Site Plan Name: Block No.
Project Name:
2
-- 1000
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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/boors _Pond
ectric _Plumbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ` yy Utilities: _Sewer 'Septic Building Height:
_ �- _
Name j21 Name: O-kt (�7- U
IC
Address: Company:
City: r cSJ � : `. ;r' • ,State:'.:,;;. Address:-_• S� me_n
Zip Code: Z Fax: City: ' fGS7Z.CL� State:
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Co — Fax:
Phone No. Jr ; .... ,,.,. p
E-Mail: z9zaZ Ph6ne'No' Z — 3 Z-3 :5;
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) oU vlL . State o County License /-'7-
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: Narne:
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
with lender or pn attorney before commencing work or recording our Notice of Commencement.
Signatur of 0 ner/Lessee/Contractor as Agent for Owner
STAT OF LOR1D •
COU F
Sworo(or affir ) and subscribed before me of _Physical Presence or Online Notarization
this day of 200J by
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Name of IF n making statement.
Personally Kn n OR Produced Identification
Type of Ident ' atiK Produced
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(S nat Notary Public-State of F rida )
Commission No. (Seal)
tiMING'
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REVIEWS FRONT ZONING S * �� PA IR& SEATURTLE MANGROVE
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COUNTER 'REVIEW REVIEW' REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2 21