HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMF:zr'2D FOR APPLICATION TO BE ACCEPTED
f Permit Number:
Date: f� li - r) aI
Lio }?ll� RECEIVED
c t.
Building Permit Application JUN 2 3 2021
Planning and Development Services St Luci . • unty
P
Building and code Regulation Division Comrhercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: �eJ\a"\aN;
Address:
lit CV
Property Tax ID #:�1 Lot No._
Block No.
Site Plan Name:
Project Name:
New Ele
d Electrical ivieter
(Affidavit required)
Additional work to be performed under this permit -chock all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers — Generator
Total Sq. Ft of Construction:
r-nct of Cnnstruction: 5 10. 00(7)
windows/Doors _ Pond
Roof Pitch
Sq. Ft. of First Floor:
Utilities: Sewer _Septic '
Name
Address:A:
City: 1��"y(1Q State:
Zip Code: - C1 Fax:'1Ta - 59�5 -6 Q1
Phone No. -7�Q- (alb 7�i
E-Mail: I V)f?VI0 ACA + bV) C CO IMCCA 4. 0
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
City:
Zip Code:
Phone No
E-Mail
State or County Lice
If value of construction is 2500 or more, a Kt:LUK+JCU Iwucn vvnu nc.. a .......
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Building Height:
Fax:
State:
MORTGAGE COMPANY: _Not Applicable
DESIGNER/ENGINEER: _Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLtTITLE 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
With lender or an attorney before commencing work or recording uour Notice of Commencement.
Si&Fnature of 0vyn6r/ LesseeKontractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Sk
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
thisa.3 day of 7SO f\*, 20%A by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced S L b ,,
(Signature of Notary PUlic- State of Florida )
Commission NoAVA0-k%%TN (Seal)
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLET
DEANNA GIVENS
Notary pu li+t t f Florida
J 4m+
My LOMm. Expires Jan 835 023
Bonded 9fP96k9Mt1MYtarY Assn.
SUPERVISREVIEWOR I REVIEW PLANS � VREVI WON I SEATURTEV EWLE I M EVIEWVE