HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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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
PERMIT APPLICATION FOR: Gcs � t�
'PROP095D IMPROVEMENT LOCATION;
Address:
Property Tax ID #:
Site Plan Name:
Project Name: �jy
000 L.o
Permit Number:
Building Permit Application f
Residential O
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit — check all that apply:
_MechanicalGas
Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
r uu
Cost of Construction: $'_T)91
Name d1.S
Address:UOCI A'
City:
Zip Code: , Fax:
— Generator
Sq. Ft. of First Floor:
Lot No. QL
Block No. I.C96
Windows/Doors _ Pond
_ Roof Pitch
Utilities: _Sewer l Septic Building Height:
State
Phone No. La- b(A 5 6 E-
ntail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: �,Y Q)I r--\(_kXj YXJ0
Company: T Q 1 j 1°U
Address:�.
City: V' -Zee � r State:
Zip Code: 3kAQ9 Fax:
Phone N(�(��('�QAOX �pp
E-Mail e IXIIY 3 CAw
State or County License l sP n
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 App
Name:
Address:
City: State
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Not Applicable I BONDING COMPANY: _Not Applicable
Name: _
Address:
City:
Zip:
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 beteVcommencing work or recording vour Notice of Commencement.
Signature of Co trac t - or- wner Builder as applicable
STATE OF FLOR�A�C
COUNTY OF
Sworn to (or afflr d) and subscribed before me of �� Physical Presence or Online Notarization
this " day of li 2 by
1rnr11 i(.'o f1 o
Name of person making statement.
Personally Known Ic— OR Produced Identification
T e of Identification Produced
(Signature of Notary Public -Mate of Florida)
DANIELL.E CONCALVES
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Commission No. (Seal) - h: MYcbMMIsSI0NMGG232946
EYI'II�,E3: Junp27, 2022
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