HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -6 SC
Date: ��' oZ� Permit Number: Qk09
RECEIVED
o " SEP 13 2021
H = BuildingPermit Application p p St.Lucie Co my
Planning and Development Services Permitti g
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: LiaOa C�1 fy Lone f-y. ptex(-& FL ZL- CIL_l
Property Tax ID#: ���1 a.•0 \a` 00NO- 000- oZ Lot No.
Site Plan Name: Block No.
Project Name:
WOW
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:
Cost of Construction: $ `MJ0 Utilities: —Sewer _`Septic Building Height:
_ !' a sq
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Name W VCi
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Address:
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City: et (Xeyce� =State:-EL Address: !
Zip Code: 1_:Y4Q)7 Fax: City: � State:
Phone No. Sob- (aqq--I-3gq Zip Code: iFax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above State or County License
If value of construction is 2500 or m re,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 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.
Signature of Owner Lessee/Con actor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworryt�p(or affir )and ubscribed bef re me of Physical Presence or Online Notarization
this�day of 0 2W by
Name of person making statement.
Personally Known OR Pror Ide tification V
Type of Ide tification Pro uced
(Signature of Notary Public-State of Florida):. _. KAREN S. NIELSEN
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=o <<;-;State of Florida-Notary Public
Commission No. (Seal) =„ ._ Commission # GG 207484
My Commission Expires
°;,`,���` June 12, 2022
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