HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '•�'�-\. Permit Number:
Mr ILUCHE
Building Permit Applicati
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
/11
Site Plan Name:
Project Name: _
JUL 3 0 2021
. Lucie County, Permitting
Residential
L*No.
ock NNo
I
// e�-
L
A A,
�' J
No Wc t
to o I s✓
r t c L
(2 x
U/
New Electrical Meter
Second Electrical Meter
E
CONSTRUC]TION INFORMATION
V +M f
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: Z 2Z Sq. Ft. of First Floor:
Ub
Cost of Construction: $ 2 ,-%OCR . Utilities: —Sewer —Septic Building Height:
,
QWNER
jf
{,."Its
CONNTR4ACTOR
Na"me (AJQ GC fC, c.
Name: fr9��,��
Address: R0 GOn U 66Lo,e (C
Company:
Address:
City: f C0 I Qr� ( C e- State: (,
Zip Code: 2 Fax:
City:
State:
Phone No. i'I �' ,� -
Zip Code:
Phone No
E-Mail
Fax:
E-Mail: 5G.1 qA�i� S 63 1 Xi! y a Gy n
Fill in fee simple Title Holder on next page ( if different
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.
r
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.
Signatt�'re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA,
COUNTY OF �u
Swot toor affirmed) and subscribed before me of _ Physical Presence or Online Notarization
'-day
this of � 20XI by
`."( , 1
Name of person making statement.
Personally Known OR Produced Identification T L ��-
Type of Identification Produced
-
(Signature of Not AUGHN
1PN bg i�
_=o YP ,State of Florida Notary Public
Commission No. _, = Commissi(6 A)GG 270079.
eF My CommissionExpires
OF 2 fires
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE '
COMPLETED
Rev 512OIZ1