HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �1� % Permit Number: _
0 Llo Clau1C � RECEIVED
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- ° I'W" Building Permit Application SEP 13 2021
Planning and Development Services St. Lucie County
Permitting
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: -zD,? Nel -low%- a� be /-:K
Property ax ID #: -��(�J �Oe �'�Q����O�� — � Lot No.
Site Plan Name: Block No.
Project Name:
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REMO.•
7
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit- check all that apply:
Mechanical — Gas Tank _ Gas Piping — Shutters —Windows/Door s _ Pond
Electric Plumbing — Sprinklers _ Generator _ Roof Pitch
Floor:
Total Sq. Ft of Construction: Sq. Ft. of First
Cbs� t-6f-CCons'�A&tilities: —Sewer Septic Building Height:
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-Name
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Name:
Address: y �� % d
Company:
City: ���.✓�•� Stater
Address:
City: State:
Zip Code:'-:: s19 F Fax:
Phone No.S-6 ^ eF L—�/D
Zip Code: Fax:
E-Mailer ^Pe�Gie/`o.td c r" g('
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 more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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
improve nts to your property: A Notice of Commencement must be recorded in the public records of St.-
Lucie unty and posted -on the jobsite before the first inspection. If you intend to obtain financing, consult
wit end ` or an attorney -before commencing work or recording our Notice of Commencement.
ure of ownerl Lessee/ ont >116as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swor o (or affir d an subscribed beta 1 me of _ Physical Presence or Online Notarization
this day of 2001by
��I�NIAI_� �P�ZELI I�
Name of person making statement.
Personally Known OR Prod uce44dentification
Type of Identifi tion Pro ed i
(Signat
IMP8 pt,1� KAREN S. NIELSEN
Commi
a-NotarJgA*)ic
iD�FVO
_*# GG 207484
oision Expires
June 12, 2022.
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Rev 5 2 21