HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Oo F=UR� RECEIVED
Building Permit Application NOV 2 9 2021
Planning and Development Services St. uc ounty
Building and Code Regulation Division Commercial Residential rmitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
I PERMIT APPLICATION FOR: I )
Address:
Property Tax ID #:
Site Plan Name
Project Name: —
New Electrical Meter
Second Electrical Meter.
(Affidavit required)
Lot No.
Block No.
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 Constructipdl:-15�Q �' Utilities: —Sewer _Septic Building Height:
ON
Name le p•mi 11A1k
Name:
Address:_ qs�:a-p
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Company:
City: -r Z v P'1-r2C;e Stater
Zip Code: Fax:
Phone No. a&3 - a,�r; Q
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail: IrakL—tAV CMP.-il..a (Ofir
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Fill in free simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail l
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:
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
improv ents to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie C�un�y and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with Ignde or an attorney before commencing work or recording your Notice of Commencement.
nature of owner/ ' ss e/Contracto as Agent for Owner
STATE OF FLORIDA f
COUNTY OF
Sw (or affirmed) and su cribed before Ime of _ Phi ysical Presence or Online Notarization
V
thi��day of k2n , 20�py
LhA T) Iow)1�
Name of person making statement.
Personally Known OR Produced Identification.
Type of Identification Produced El f) r/
(Signature of Notary Pu ° HY gt°a ea)LEN VALIGIIN
°{ Florida-
Co Notary public
Commission No. %�� oP?•' M i0� # GG 270079
missio
n Expires '
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