HomeMy WebLinkAboutBUILDING PERMITAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / �(
Date: ZI Permit Number:
SM,�71. C RECEIVED
° , SEP 0 1 2021
Building Permit Application
St. Lucie County
Planning and Development Services CZ
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Building and Code Regulation Division Commercial Residential Q�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578
PERMIT APPLICATION FOR: _LsZ1,vE, WKN
Address: H�'D_L- h&4IN
Property Tax ID #: 13�z- L) Vr 0,001 - o00 b Lot No.
Site Plan Name: nnBlock No.
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Project Name: w6 f )t'W' �
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New Electrical Meter Second Electrical Meter (Affidaviitp� required)
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Additional
work to be performed under this permit- check all that apply:
_Mechanical —Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction:
Sprinklers _ Generator
Windows/Doors Pond
Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer Septic'
Building Height:
WNW
Name U4�`9 9�i/��+
Name:
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Address: I �' �'t'�S ^ ht7 -
Company:
City: f�►✓)' �`� State:
Address:
City: State:
Zip Code: �'� Fax:
Phone No. jq-)_ 21�Q0yk0
Zip Code: Fax:
Phone No
E-Mail: h •�a1� � � @ 9""1O`�'�_'` V-
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is regwrea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
X WN
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
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 onan attorney before commencing work or recording your Notice of Commencement.
Signature of
ctor as Agent for Owner
STATE OF FLORIDA I
COUNTY OF
Sworn to (or affir ed) an subscribed bef9 �rQ me of Physical Presence or Online Notarization
this day of _20vj by
Name of person m
Personally Known OR Prod
Type of Identification Produc(q_
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
n
KAREN S. N►tuZ>CIN
State of Florida- Publio
Notary
Commission # GG 207484
My Commission Expires
June 12, 2022
SUPERVISOR I PLANS I VEGETATION I SEATURTLE I MANGROVE
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