HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:.
RECEIVED -
OCT 07 2020
BuildingPermit Application St. Lucie County
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Permitting
Planning and Development Services
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: 2_go� Cn(-c c. g9taA
Property Tax ID #: 2,4U - 21 - 006 ! - 000 -L9 Lot No.
Site Plan Name: Block No.
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Project Name: _ _C&a) J� l_C(rlooY-4
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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: $(()(� Utilities: _ Sewer _ Septic Building Height:
Name _SIR_S/weQ,�1,KD05".
Name:
Address: 2-90 1 2" �1 ..
Company:
City3F - 1ef C-0- State:
Address:
City: State:
Zip Cod l�' a Fax:, ..
Phone :=D LP1"2_— 6g 3J . E-
'Zip Code: Fax:
Mail:hC1\C,C1�pop -'10 0�)k • C.6ni
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License
from the Owner listed above)
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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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 attornev before commencine work or recording your Notice of Commencement.
Aigatur&lf
O er/ L ee/Contractor as Agent for Owner
STATE OF FLORIDA �+
COUNTY OF n
Sworn o (or affir subscribed befo``e me of
Physical Presence or Online Notarization
this day of 2Q1 —by
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Name of person making statement. /
Personally Known OR Pro Identifica ion
Type of Identificat' n Produced
4
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
KAREN S. NIELSEN
;State of Florida -Notary Public
* Commission # GG 207484
%4rF o° My Commission Expires
June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21