HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICA LEI FO MUST BE CO PLETED FOR APPLICATION TO BE ACCEPTED
Date: �A o�l Permit Number:. oq, ~ Q J�
RECEIVED
O
:.. L : °rry .. 4"Ift :o-- SEP 01 2021
Building Permit Application
Planning and Development Services St, Lucie County
Building and Code Regulation DivisrlIon=�-�OCllmerClal} �~ Residential
2300 Virginia Avenue;,Fort°Pierce Fli 34982
Phone:'(772) 462=1553 Fax'.•(772) 462-15713 ' .7bbG..FU.ndIng
PERMIT APPLICATION FOR: K
- PRQPQS,ED-IMP-ROVEMENT'LOCATION:
Lot No.
• !
Project Na e: CIC
KE "&& ►
New Electrical Meter Second Electrical Meter (Affidavit,required)
CONSTRUCTION INFORMATION:. ;
a
Additional work to be pe' ormed under this permit— check all that apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters Windows/Doors _ Pond
Electric I Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $I'I (� Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:; ,
CONTRACTOR:, -
'Name i M
Name: Sc��
Address:
Company:
Address: 1
City: X State
Zip Code: �� ' Fax:
Cit State
Phone No. ' — �L-Q E-
Zip Code. Fax:
Mail:
Phone No �J
Fill in fee simple der on next page (if different
E-Mailfrom
State or County License
the Owner =ove)
If value of construction is 2500 or more, a RECORDED Notice of Co,"rpjrnencement is required.
If value of HAVC is 0,500 or more, a RECORDED Notice of Commenc6ffient is required.
,SU-PPLEMENTALCONSTRUCTION LIENIAW INFORMATION : s:
DESIGNER/ENGINEER:. Not Applicable MORTGAGE COMPANY:_V, Not Applicable
Name:Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: C& Not Applicable BONDING COMPANY: _"ot 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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 playing 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 attornev before commencine workor-r'aordina vour Notice of Commencement.
'
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Sig ature of Owner rac r as Agent for Owner
`SPpY PUB
KAREN S. NIELSEN
STATE OF FLORIDA 3e° `�� to of.Florida=Notary Public
=' •_ Commissio'n # GG 207484
�—U
COUNTY OF [.I �OFF�°��
'rIIII0
My Commission Expires
June 12, 2022
Sworn to (or affirm d) and sub cribed before me of v Physical Presence or
this 3( day of 20 '21 by D n 6n 46i_V1-C"5a PSU-I
Name of person making statement.
Personally Known OR Produced Identification
Type o Identification Produced F-lixyl��404 hyf V..Ud Lt ' /K U
!2!� '" G'l/
(Signature of NotaryPublic- State of Florida)
3121
Commission No,�jd(LG'OZSeal) :;"�,•• HAssnaSa.a=R,A
?°
hOtdry PUD.Ic state o" -.oric,
Notari ation validates h► �: Commissior a GG 3»0327
s•. >a
Signature only, ? 1 'cx:;Ires
My COMM. :L. 23. 2023
1
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not document content �6A,
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