HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED'FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
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- ' Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce. FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Property Tax ID #: UW3 `
Site Plan Name:
Project Name:
OCT 0 7 2021
St. WOO County
P®rrfiilttlljg
Residential
Lot No.
Block No.
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION IN'FOR�MATIO'N:
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:
C f_Constructioa-l-p X Cf--z
Sq. Ft. of First Floor:
Utilities: -Sewer —Septic Building Height:
OWNER/LE-�StSEE:
CONTR CTOR:
ame t 'r.,
Name:
Address: Sa
Company: ,
City:State
Zip Code; S Fax:
Phone No.�S (3s %�'1-®�-i4� E-
Address:
City: State:
Zip Code: Fax:
Phone No
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Ad d ress:
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 commencing work or recording your Notice of Commencement.
nat 0 r ssee/Contractor as Agent for Owner
STATE OF FLORIDA f
COUNTY OF . , �U Q.)o
Sworn o (or affir d subscribed befo e of Physical Presence or Online Notarization
this day of ) a 20y
Name of person making statement. /
Personally Known OR Produce Id tification
Type of Ident' cation Prog ced
L L
A
(Signature of Notary Public- State of Florida)
�� KAREN S. NIELSEN
`&,p';State
Commission No. (Seal) �_��°�
of Florida -Notary Public
=* * Commission # GG 207484
e ' My Commission p
'i °.�� CiiExpires
June 12, 2022
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Rev 5/20/21