HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CON _'fED FOR APPLICATION TO BE ACCEPTED
Permit Number: 0 1y
Date:
llO LU! QQE 1yRECEIVED
0.
Building Permit Application JUL 2 g 2021
Planning and Development Services Ludo County
Residential permitting
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Site Plan Name: Block No.
Project Name:
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RIMM"
REM
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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 _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
q
Gostof'Con t uction: $ ! '� m Utilities: —Sewer —Septic Building Height:
-' -_
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f Name L�(�t.( �S o r- Name:
Address: �r3'1 S` ��'oC� S-Qf(74 CQmpany:
City: /erC State: Address:
1 Zi State:
Zip Code:o� 9 g_S Fax: City: i
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)'iPh�one Now. -1 7 Z" � Z E, " 'S T— Zip Code: Fax:
E-Mail: t I-)07 /
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Fill in fee simple Title Holder on next page ( if different E-Maid
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.
4e
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:
Ad d ress:
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 an attorney before commencing work or recording our Notice of Commencement.
S`gnature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF t+ -r
Sworn to (or affirmed) and subscribed before me of VPhysical Presence or Online Notarization
this 4ga day of _-'9>L�, 20?_( by
Name of person making statement.
Personally Known OR Produce Identification
Type of Identification Produced
(Signature of Notary Publi i0ate of Florida) ,."aYp HEATHER BURFORD
1P " G
State of Florida Notary Public
Commission No. (Seal)bf PQe Commisslon'# GG 183217
My Commission Expires
�"`��`' February 'o6,'2022
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