HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �7z &
9 l!o LUCE - pECE1VED
�Q 2021
Building Permit Application s�P o
Planning and Development Services St. Perm11ci1 County
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: -bn- c, ��Iq�. �D
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`PROPOSED IMPROVENIEN�LOCATION "`�' ra
Address:
Property Tax ID #: -511 0 o lgal U 1 11 lbw
Site Plan Name: Le BkL GV31I Q &YN Y""I 4
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
P4echat f. � 7 Gas Tank _Gas Piping _Shutters
.. l .
_Plumbing _Sprinklers _Generator
Lot No.
Block No.
Windows/Doors _ Pond
Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 2—d o-O Utilities: _Sewer _Septic Building Height:
OWNERLESSEE ` �`
Ar
CONTRACTOR�� t f`
Name ��a� �-� UU �'�v��-2'Sb�
Name:
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Address: � 3d &VV'N M4Lk- La) _
Company:
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City: State:
Address:
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Zip Code: `1 J `2--_ Fax:
City: 7�-\
. V1VC="YL -e- State:
Phone No.
Zip Code:
3r(� 5 � Fax:
E-Mail:
Phone No
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Fill in fee simple Title Holder on next page (if different
E-Mail ILASS
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-from,thpl;Qwner listed above)
State or County
License
If.Value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Ifvalue 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 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 1 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 attornev before eommencine work or recording vour-Alotice of commencement_
i
Si nature " Owner/ e / n o ent for Owner
ature o ntractor/LiEgnisf
STATE OF FLORIDA
OF FLORIDA
COUNTY OF
COUNTYOF
and subscribed before me of
Sworn t raffiimed) and subscribed before me of
Swo4ml6kra'ffirmed)
sical Presence or
Online Notarization
hysical Presence or Online Notarization
this Z day of
202gf by
this ,& day of 20,-�b by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced !�/
Produced /D
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Si ature of Notary Public -State f Florida '%°;,~, °
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(Signature of Notary Pub ic- State of F rida)
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