HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a, (00�
Date: Permit Number: U
I � ��� R RECEIVED
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Building Permit Application OCT 0 4 2021
Planning and Development Services St. P cieftt nunty
9
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address
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Property Tax ID #: 04 6Co Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
CONSTR CT(ON"UN FORMATION =Y
Additional work to be performed under this permit- check all that apply:
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_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing �,,/ _ Sprinklers
Total Sq. Ft of Construction: 66
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ `%C ^ Utilities: —Sewer —Septic Building Height:
'0111/NERf LESSEE µ , t
CONTRACTOR
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Name 1 .,f c�N or r,., 2
Name L®AT. O 66..��
Address:5�31,3 2LO12
Company
City: _ State:``L
Address:
City:, chit" State:
`'2ipp'C6de3
Phone No. -,5- 536
Zip Code: ,31f94� Fax:
Phone No ?_ �i
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E-Mail: Jn��S��?7��ia,J� 1 f ./> (
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E-Mail t l ( ��J & �'he't 321 GQ K49V
Fill in fee simple Title Holder on next page (if different
State or County License C?C 1255S FP
from the Owner listed above)
If value of construction is 2500 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 SIMPL'&lT' LE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 attorriev before•commencinR work or recordinp, vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
451r- WLO__
STATE OF FLORIDA
COUNTY OF 5�_
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
�hysical Presence or Online Notarization
Physical Presence or Online Notarization
ttiis_.�L day of 202� by
this L day of 4 2021 by
Name of person making statement.
Name of person making statement.
Personally Known 4— OR Produced Identification
Personally Known �-- OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
CY.v
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(Signature of Nbtary Public- Stat F
�u Notary PubNe Stele of Fitride
ture o• Notary Public- S
,y*'i Notary G of Florid
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Commission No We 113 aQ �6e ryn G Drawdy
r, My Commisston GG 292
Com fission No.G lW Q misa 292585
5 �p
;ii Expires 02/11/2023
or ti°F Expires 02/11/2023
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Rev. 5/b/ZU