HomeMy WebLinkAboutBUILDING PERMIT APPLICATION r
All APPLICAABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater \ d\�.1 Permit Number:
f..l1o.luc- DIE" i{ECEIVED
° EP 3 � 2021
Building Permit A licatOn'
g p p St.Lucie,County
Planning and Development Services Permitting
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982 -
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
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PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax lD#: C/� ��XJ� �" Q'3Z, 00 1 Lot No.
Site Plan Name: I Block No.
Project Name:
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TAILED DEG«R�IPTIO (?F WOR�K.:
�tiGPy
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORto ATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters 1._Windo s/Doors _Pond
Electric —Plumbing _Sprinklers _Generator - _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 4� Utilities: _Sewer Septic Building Height:
—I,
(JWNER LE�S`�SEE: CONTRALTO
Name /l Name:
Address: v Company: 1
City:pfta State:_ Address: A I'
Zip Code: &5 Fax: City: l 1 State:
8
Phone No. E- Zip Code: I Fax:
Mail: Phone N 7 l
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above). State or County:Lice
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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.
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S 'PP 0M TALC« STR ION EN LA INS«RM TION•
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone: I
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City: I
Zip: Phone: Zip: Phone:
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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 per 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 restrictions1which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,inlall 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:Y ur failure to Record a Notice of Commencement may result in playing twice for
improvements to yo property. A Notice of Commencement must be recorded i I the public records of St.
Lucie Coun y n p ted on the jobsite before the first inspection. If you intend to,obtain financing, consult
with lend r r torne bef a commencin work or recordin our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLOR DA
COUNTY OF •
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
thisl, day of 'Sk� 2%A, by
Name of person making statement.
Personally Known OR Prod d Identification
Type of Identification Produced L
(Signature of Notary ublic-State o GNEN5
DEAD AState oa6359da
Commission No."M\ 2025
`omM 'ttona No a�Assn.
.- res `
gondedthro�gh
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21
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