HomeMy WebLinkAboutBuilding Permit Application, pg 2All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10/28/21 Permit Number:
LV WO
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phol
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
A Not Applicable
State:
X Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:
Phone:
X Not Applicable
State:
X Not Applicable
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 permitwill 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 CountTInd posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lencle
ror an attw,�(ey before commencing work or record€n'jit- vour Notice of Commencement.
ig ur O er/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Martin
Sworn to (or affirmed) and subscribed before me of X Physical
Presence or Online Notarization
this2$}bday of _ October 20 21 by
William H. Miller
Name of person making statement.
Personally Known X OR Produced Identification
pe of dentification Prod ed
(Signature ONotary Pudic- State of Florida) ,
Wynn Alien
Commission No. (seal)
Comm.0130368562
� 41
FJor dW ThNAm.Homey
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW
REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 12-0121