HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMF __ _ _D FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �� �% ✓"
Cz'-J P a RECEIVED
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SEP 2 2 Z021
Buildin Permit Application
g 5t L.ualo Countu
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
Permitting
Residential -
PERMIT APPLICATION FOR: � � ac
PROPOSED IMPEtOEME'IV`T LCtCATION
Address: - 10) P h 1 eC ibk mc1 -0-1SQV\ 3
Property Tax ID #: 11 Lot No.
Site Plan Name: fy1cd f% `tCoA i E.- v0 5 �o �C_a4' C. VC.N C� ���p— �[: Block No.
Project Name: Nl`c,, ejWC3-c.)C_I -� �fl\r f c �� (i� G l `� C3 i1 I
DETAILED, DESGRIPT;ION tOF WQRK
New Electrical Meter Second Electrical Meter (Affidavit required)
. C""-' RU '' " INEQRMATIQN
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: $ i ���(', ,e. Utilities: _Sewer _Septic Building Height:
OWNER/LESSEyE _
CONTRACTOR': _
Name ' P
Name:
Address: ocY__ i I 1
Company:
City: f..Gck State: 1,
Zip Code 33��q Fax:
Phone No. ;s('(" 3 OJT—ot.q�g
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail: Co^
Fill in fee simple itle 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.
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DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicab.le
Address:
Address:
City:.
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 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 attorney before commencing work or recording your Notice of Commencement.
Signature of Olvne / Less /Cont actor as A nt for Owner
STATE OF FU A
COUNTY OF ,
Sworg to (or affirmed) and subscribed before me of �ysicaI Presence or IOO'&line Notarization
this day of 20 Ziby
Name of person making statement.
Personally Known OR Produced Identification
Type Identification Produced
,aq - #, 4,&�z
(S gnature of Notary Public ate of Florida)
Commission No. (Seal)
HEATHER BURFORD
';State of Florida -Notary Public
_• •= Commission q GG 183217
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My Commission Expires
F9bruary 06, 2022
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