HomeMy WebLinkAboutBuilding Permit Application I
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-All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` �0 ' a� Permit Number:
91T.EC�CQr
^ i RECEIVED
Building Permit Application
JUL 3 0 2021
Planning and Development Services
I St.L ie County
Building and Code Regulation Division Commercial Residential ermbng
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578
,� PERMIT APPLICATION FOR:
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Address: / g0�o Pit r G (� 1 rf_?ie_fce rL- 34q 6 -
Property Tax ID#: -��Q�o (3 Lot No.
Site Plan Name: Block No.
'Project Name:
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New Ele rical Meter Seco-41 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: 40 Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
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Name Yl t'IQ.
c _ . �_,a_.��, .:.�.•, -A....:�,...r�nL..-.�. Name:
Address:_75?0b POLP,� -4CG I VPi Company:
City: �((�i�GP� --State '' 'Address:
Zip Code: 34(36I Fix,. •.,.. .
City: State:
Phone No. �]72,- $DI "1p�f Zip Code:. Fax:
E-Mail41^1rG�,[e-1'1/�1C�I"Ip(dLiLC I�QC - C.0P4 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.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _JZIVot 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 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 Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA - (�
COUNTY OF rka In V��
Sworn to(or affirm d) and subscribed before me of Physical Presence or Online Notarization
this`"� day of 20,),i by
Name of person making statement.
Personally Known_ OR Prop u ed Identification
Type of Identification Produced
3,M(x 4- e I I -
(Sign Lure of Notary Public-State of Florida)
Commission No. 33�W s (Seal) ; Y��o., JEANALPITTS
'?• 4�' Notary Public-State of Florida
�`• o" Commission#GG 338475
My Comm.Expires May 27,2023
Bonded through National Notary Assn,
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Rev 2 21