HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�0 r J
3; RECEIVED
p 9 s •:;.--• � Buflding Permit Application
Planning and'DevelopmentServices AUG 18 2021
Building and Code Regulation Division Commercial Residential �ZucieCounty
2300 Virginia Avenue, Fort Pierce FL 34982 Permitting
Phone: (772)462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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Address: 33Z �C� �f' 1ercc, FL 34c?s'1
Property'Tax ID#:��� l ' 0 yW•o ''I •00�� Lot No.
Site Plan Name: Block No.
Project Name:
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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: r Sq. Ft. of First Floor:
Cost of Construction: $ ���,� •(�� Utilities: _Sewer _Septic Building Height:
Name 1 Name: -
Address:'S 2 (:)-'k61-J L'.k�r- Company: f 1 Tfh Ir^
City: �'� ipiuee State: Address:
Zip Code: 34951 Fax: �Q City: f-E %�i?eQ" '.' '"` atat �:;
Phone No. 7 61 - 340- -71 Z6 Zip Code: 5ggq Fax: ' 719 A10 ��c�
E-Mail: -%iqu '!9 @ hdeft,I. Goe" Phone No
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Fill in fee simple Title Holder on next page(if different E-Mail Z6e.L16762 CJ/Yu t _,!?0M
from the Owner listed above).'- State or County License
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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 TITL€: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•perrnit 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,finalncin_g,.consult
with lender or an attorne efore commencing work or recording our Notice of Commencement.
Signatu Owner/Les se ontractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF , X_a(?,c
Sworn to(or affirmed) and subscribed before me of _ZPhysical Presence or Online Notarization
this 1'2 day of Quo 20 W by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary lic-State of Florida
Co o. BRENDAKFFNEy I)
MY COMMISSION#HH 131294 -
po'p EXPIRES:July 22,2025
wINOV nUU Notary Publi Under1NR em .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIO.,N' 'SEATURTLE• J MANGROVE
COUNTER . REVIEW. REVIEW REVIEW- REVIEW `• -REVIEW . REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 2 21