HomeMy WebLinkAbout Building Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE-ACCEPTED
Date: Permit Numberc V lX
DEC 29 202,
011 LMMIE St.Lucie
Perrnitt ng my
building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
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Property Tax ID#: f P `C Lot No.
Site Plan Name: Block No.
Project Name: f
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New Electrical Meter Second Electrical Meter (Affidavit required)
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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: $ � Utilities:_ _Sewer _Septicl, Building Height:
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Name lS O�J Name:
Address: Company:
City: State: Addre
Zip Code: 3 Fax: City: State:
Phone No. E- Zip Code: y ax:
Mail: Phone N
Fill in fee simple Title Holder on next page (if different E-Mail GGJ��
from the Owner listed above) State or County License 1�c /-300 6 yi
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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ROSE i is ...s....:_
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: r_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 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
improvem nts to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie Cou y a d posted on the jobsite before the.first inspection. If you intend to.obtain financing, consult
with le o an attorneybef re commencingwork o_r.recordin odr Notice of Commencement.
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S i g n a t u or-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed)-rid d subscribed before me of :Xhysical Presence or Online Notarization
this ` Nay of C , 20_,X by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced 0
(Signature of Notary Public-State Flor4
Commission No. N VAUGHN
�_ Te of Florida-Notary Public
=� "= Commission #
GG'270079 '
OFF �•. My,C9mmisslon-Expires
Odtober 22, 2922 '
REVIEWS FRONT ZONING %SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21