HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 09 Lot-, Permit Number:
RECEIVED
o'
AUG
Building Permit Application St. Lucie 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
PERMIT APPLICATION FOR: IS-i-'i
Mig
13 1
RX I
Address:
Property Tax ID #: 13 2 C L- t) (D Lot No.
Site Plan Name: Block No.
Project Name:
U 4 .sV
I 44C: k Tke_ A ks "'04 'k�.
New Electrical Meter-S P c "on d lectrical 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: $ grg)(0,100 Utilities: Sewer Septic Building Height:
171 0-11 "1 WIN -NO El
Name
Name,
'
Address:
company:'
City: A State: L
Address:
Zip Code: 3 i Fax:
City: State:
Phone No.
Zip Code: Fax:
E-Mail:j G C-ok�\
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.
IVA"
6b� 3L 3 V -o � 4( '0 3
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: -Phone
City: State:
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.instaIlationas 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 bui(d'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 attorney before commencing work or recording our Notice of Co'nImencement.
SUature of Owner/ Lessee/Contrac or as Agent for Owner
STATE OF FLORIDA 1
COUNTY OF S'T 1-UG +-e -
Swor_L n jto (or affirmed) and subscribed before me of Physical Presence or Online Notarization
r' this day of ,gv v , 20 21 by
Name of person making statement.
/
Personally Known OR Produced Identification
Type f Identification Produced yg?
( n t e f No ary Pub c- tate of Florida) =°"Va Pie`° Margaret M. Aguero
Q �n State of Florida
Commission No. CC%% L (Seal) j -My Commission Expires 04/26/2023
Gomml®alon No. GG 302882
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Rev 5 2 21