HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �J
Date: Permit Number: y �`
cg;!�Mc ELLUME
RECEIVED
U' ' ' '` Building Permit Application
Planning and Development Services SEP 16 2021
Building and Code Regulation Division Commercial Residential.,.,;, count1g-
2300 Virginia Avenue, Fort Pierce FL 34982 'ermittinq
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
a
Address:
Property Tax ID #: _ Lot No.
Site Plan Name: _ Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:§
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric V Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of -First Floor:.
Cost of Construction: $ (oCO- CXD Utilities: _ Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR: u�
Name l�okj AILS, C° (yYV\ �C
Name:
Address: y 1 &0
Company+H tl ( r)_NA�f
City-tDcA I?f`eiC'e State-k L
Zip Code: .3`4(i44 t Fax:
Add ress:'7<c l
City: je C C State �-
Phone No.%:)-1 -SI Z -1401 U 3FS
Zip Code: 399 S Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different
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State or County License CFC 1Liol7 ���
from the Owner listed above)
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 Home Owners Association bylaws
any applicable rules, 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
ith enckr orAn Atttorney before commencing work or recording our Notice of Commencement.
ature o see/Contractor as Agent for Owner
S�TATE
OF FLORID25.�
COUNTY OF
Swor to (or affirme and subscribed before me of Physical Presence or Online Notarization
this day of 20 ZPy
Name of person making statement.
Personally Known OR Produced Identification
Type Produced _
�oflIdentification
!v
(Signature of Notary Public- Stat of Florida )
Commission No. (Seal)��"
\�pRV PL HEATHER BURFORD
r° a`Pc State of Florida
-Notary Public
9 •= Commission # GG 183217
`
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