HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLIC BLE�,NFCI
MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I
I Permit Number: a.Nd$-d$ \d
RECEIVED
° AUG 3 1 2021
Building-,lo
Permit App lication
St.Lucie County
Planning and Development Services Permittinq
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: ^
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Address: L &AA) jl or EL 7LI
Property Tax ID#: 3y\�` �dly, 1 Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Elec ical 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:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
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Name UGrA(- G� -)- Name:
Address: 'C 5 S t S AWJi r Company:
City: 0 r-'r State: Address:
Zip Code: Fax: City: State:
Phone N *0 '-10 6�5 Wf-Y Zip Code: Fax:
E-Mail: Ct-r Y,Ac' •-} W r cr. Ilk Phone No
Fill in fee simple Ti le Holder on next page( if different E-Mail _
from the Owner listed above) j 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.
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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: 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 Ae,jobsite before the first inspection. If you intend'to obtain financing, consult::
with lender or an attorn before commencing work or recording our Notice of Commencement.
/I U/C
G`
gna ure of Owner/Lessee/Contractor as Agent fo wne i\
STATE OF FLORIDA
COUNTYOF
Sworn to(or affirmed)and subscribed before me of _Physical Presence or Online Notarization
this` day of 20b-,\ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced Y �1�
(Signature of Notary blic-State of Florida
5
pEANNA•StaLate Of Florida
Commission No. N6 �••• )cte
�O �'! No Com lssion HNap86352025
res
Com hNatioralNotar!
9onded thtou8
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE. MANGROVE
COUNTER REVIEW REVIEW :'•;REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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