HomeMy WebLinkAboutBuilding Permit Application~~'
All APPLICABLE INFO MUST BECOMPLETED FOR APPLICATION T00EACCEPTED '
Date: Permit Number:
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N Building . nn��� x��� nn ~x nx
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New Electrical Meter Second Electrical Meter
Additional work tobe performed underthispennit-chockuUthatapply:
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—Mechanical-.- GasTank —Gas Piping Shutters
Windows/DoorsPond-
Electric Plumbing P|umbin8 Sprinklers Generator
Roof Phzh
Total Sq. FtofConstruction: ~ 3q.Ft. ofFirst Floor:
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U Cos of Construction: $ Utilities:' —Sewer Septic
Building Height: �
Fill in fee simple Title Holder on next page (if different
E-Mailh-� A06 V;,KkA,
from the Ow'ner listed above)
State or County License
'L "Cement is required.�
Notice of C6mmen
SUPPLEMENTAL CC}NSTR TION LIEN LAW INFORMATION:
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:
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: Yo failure to Record a Notice of Commencement may result in paying twice for
improv ents to your p ope y. A Notice of Commencement must be rec de in the public records of St.
Lucie ur a d p st d on t e jobsite before the first inspection. If you in rid o obtain financing, consult
with rider or n a o n b ore commencing work or rec rdin o r foot e f Commencement.
Lt
1A V>
ig r fat re of Owner/ essee ontractor as Agent for Owner
Signature of Contractor/License Holder
STAT OF FLORID
STATE OF FLORID_
COUNTY OF �
COUNTY OF '
Sworn to (or affirmed) and subscribed before me of
worn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
`
Physical Prese a or Online Notarization
day 202(� by
thi day o
IK'2024 by
this of
�!'`�D,�Name
of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification �°Type
of Identification
Type of Identification
Prod d
Prod ed
kr% Ire-
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n u o Notary Public- St of Florida)
igna re of Notary Pub; -a" te of )
Commission No. (Seal)
Commission No. (Seal)
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"me COIVMIkR$10N # G G 275060
W C MISSION # GG 2750
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REVIEW EVIEWVE
DATE
RECEIVED
DATE
COMPLETED
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