HomeMy WebLinkAboutBuilding Permit Application AllAPPLICAjOLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Permit Number:
guo fi ►7 a RECEIVED
L'�t,l OCT 11 2021
-' Building Permit Application
Bt.Luci
e County
ttin
Planning and Development Services I�er m �
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (.772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:.
Address: I /,� �t
Property Tax ID#: e'.r1 DA MD 1 1 Lot No. 'tJ
Site Plan Name: _ Block No.
Project Name:
-E
New Electrical Meter Second Electrical Meter (Affidavit required)
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. Sq. Ft.of First Floor:
Cost of Construction:$ X Utilities: —Sewer —Septic Building Height:
Name 9AM Name: /n�
Addres 1 woo Company:�t�
City: � �' State:_ Address:11)6 W1
Zip.Code: Fax: City: W ( (_t)CTJ�; State:
Phone No. E- Zip Code: 54CK 3 Fax:
Mail: Phone No "/ 722pi146-21>
Fill in fee simple Title Holder on next page(if different E-Mail IbApyIK 6MP.-d, .CkM _
from the Owner listed above) State or County License ';�LA 4
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.
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 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.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.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COU NTY OF,
Sworn to(or affirme d ubscribed bef��{{ me of Physical Presence or Online Notarization
this 'L day of 2=by
Name of person making statement.-
Personally Known OR Prod ucedk4entific io
Type of Ide ification Pr uced t.
(Signature of Notary Public-State of Florida)
KAREN S. NIELSEN
State of Florida-Notary Public
Commission No. (Seal)
_• Commission # GG 207484
''9'FOF FLOC�� My Commission Expires
June 12, 2022
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