HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED B
Date: r 9 Permit Number: (0
9Uo RECEIVED
�1 L1L� ,
o OCT 2 6 2021
Building Permit Application st,woe 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
PERMIT APPLICATION FOR:
VVL'r OAG
PROPOSED,IMPROVEMENT LOCATION: �i a."
Address: Ar"
Property Tax ID#: �y c7.Xe� C �4�� Lot No.
Site Plan Name: ;! Block No.
Project Name:
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J'bJtTAiLEb-DESCRIPTION..OF WORK = �ka
'(fir ---
New Electrical Meter Second Electrical Meter (Affidavit reqbl ired)
CONSTRUCTION INFORMATION
Additional work to be performed under this permit—check all that apply:
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_Mechanical _Gas Tank Gas Piping _Shutters _Windo`ws/Doors _Pond
Electric _Plumbing _Sprinklers Z nerator _Ro,of Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE4 COIVTRACTO'Rs
Name QL—X— Name:
Address: 5H I A- D4A&rC Company:
City: t�'M—CSC Stater Address:
Zip Code: 3 1&Z—Fax: City: State:
Phone No. ZZ"2o(— �7 ( E- Zip Code: Fax:
Mail: 5.5iirL.e, 5kt r(5 Il Phone No
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 required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL C'ONSTR'UCTIONI, LIEN LAW INFORIVIATIO'N mm
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:
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 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 attogney before commencing work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF SSIr
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online)Notarization
this`' day of bcA 20a1 by
Name of erson making statement.
Personally Known OR Produced Identification q
Type of Identification Produced .
(Signature of Notary GivENS
: y'ueIte of
Notary public S HH 086359da
Commission No WA <; (g�jission� 2025
Expires Jan Z8.ationa Assn.
Bonded through Nl votary
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION §EATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE j
RECEIVED it
DATE
COMPLETED
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