HomeMy WebLinkAboutBUILDING PERMIT APPLICATION I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE AfyCEPTED
Date: a � I a® Permit Number: a aJ41
RECEIVED
q DEC 14 2021
Building Permit Application St.Lucie Counry
Permitting
Planning and Development Services r
Building and Code Regulation Division Commercial Residential �C
2300 Virginia Avenue,Fort Pierce i'L 34982
Phone:(772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATIION FOR: A/C
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Address: V , < + 611 1)7
Property Tax ID# coo .,� Lot No. �C
Site Plan Name: Block No.
Project Name:
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Q; AILED C►���R�PTi�N flF OR _ s -
Gi Lj G 5'/�S�"soi� cf��l
New Electrical Meter Second Electrical Meter (Affidavit required)
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-TRU'CTItJ iN�EQR41/IATi'4N
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Additional work to be performed under this permit-check all that apply:
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0�Mechanical Gas Tank ®Gas Piping Shutters Windows/Doors Pond
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Electric _Plumbing -,Sprinklers Generator a�Roof Pitch
Total Sq. Ft of Construction: test Sq. Ft.of First Floor:
Cost of Construction:$® /,oDG Utilities; Sewer T Septic Building Height:
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C;1N R�, F
Name 1 2 Name: G e�
Address: �9�! Air— 5�1, Company
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City: pr -ri, State: Address: (3 f,
Zip Code:ZL1'qZ% Fax: City: M,cc!x State:
Phone No.22•r;-123' 0 1 Z 1 E- Zip Code: �((� Fax:
Mail: Phone No - �
Fill in fee simple Title Holder on neat page(if different E-Mail
from the Owner listed above) State or County License
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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.
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SOPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION!
DESIGNERANGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: 1
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 bl ild 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,1 do hereby agree that I will,in all respects,perform the work
in accordance with the appro ed-plans,the Florida Building Codes and St.Lucie County Amendments.
The following building pe it app ications are exempt from undergoing a full concurrency r w:roomadditions,
accessory structures,s ►mming ools,fences,walls,signs,screen rooms and accessory es t�anotheri non-residential use
WARNING TO O NEB: o rfailure to Record a Notice of Commencemen ay recult in paying twice for
improveme is to u property. A Notice of Commencement muye rcorded in'the public records of St.
Lucie Coun an lio)Xted on the jobsite before the first inspection. �q{{�� Intend to iobtain financing,consult
with lend r or Ott fore commencin work or record' Notice of Commencement.
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Signature o O ner/Lessee/Contractor as Agent for Owner Signat re , ontractor/License Holder
ST OF h�
STATE OF FLOj�roI ���� COUNTY FLORIDA
COUNTY OF �
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Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribied before me of
ysical Presence or :., Online Notarization Physical Presence or Online Notarization
this ` ` day of 20?6 by this '7-day of 2026 by
Name of person making statement. Name of person making statement.
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Personally Known OR Pro ced Identification Personally Known OR Produced Identification
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Type of Ident on
Type of Id ific tion YP
Y , g��
Produced ] Produced
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(Signature of Notary Pulglic ignature of Notary Public- t { lorida) hE t oRENZO
"ks9y'6y�:: IVETTE LORENZO ?°;�1��'; Notary Public-State of Florida
.�� N ublic-State of Florida g
Commission No. _ ^Uission f�GG 23069t Commission No. tee` )sion R GG 230691
A: Fs�4:` µy omm.Expires Jun 20,2022
µy Comm.Expires Jun 20,20Z2 Bonded through National Notary Assn.
NotaryAssn.
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