HomeMy WebLinkAboutBuilding Permit Application 11-Jan-2022 18:57 From: +12014556135 P.1
i,ll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t - Permit Number.
RECEIVED
JAN 12021
Building Permit Application �
.. S'' eiaiitti®n�
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
's PERMIT APPLICATION FOR; f � 1 �UAI
1
OlJ.E L T
Address: -12 N- F-t i " I
Property Tax I#: Lot No.
Site Plan Name: Block No.
Project Name:
DETAIL D DES C PTiO . a.t QR
New Electrical Meter Second Electrical Meter (Affidavit required)
CCU UC.1. N I1+JFQRMATLON.::
Additional work to be performed under this permit-check all that apply:
--VMechaniceI _Gas Tank u 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:$ Sol
Utilities: —Sewer _ Septic Building Height:
�. �........,u� ,.... ......:
... . ................
----------------------
Name Name:
Address; Company: •t Q .S
City: State:_ Addr
Zip Code: Fax
'
Clty: Qv0 ? State:
Phone No. E- ZipCode:3
Mail: N �Fax:
i
Phone No -) 7 .7 .� 1 D, - `I
Fill in fee simple Title Holder on next page(If different E-Mall
from the Owner listed above) State or County license EA 1' lo(o 7 5 Z
IF value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ^�-
If value of HAVC is$7,50o or mare,a RECORDED Notice of Commencement is required.
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11-Jan-2022 18:58 From: +12014556135 p.2
;SUPPLEMENTAL CONSTRUCTION LIEN LAW IN 3RRMATIQN.
OESiGNER/ENGINEER: __Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone;
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _•r__Not Applicable
Name: Name:
Address: Address:
city: City:
Zip: Phone, - Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is he 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 anyy 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 concufrency 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 len er or an attooEgefore Commencing work or recording your Notice Of Commencement..
Sign a of ntra r=or wner Builder as applicable
ST E OF FLORIDA I �
COUNTY OF'T.i)Wt/1
sworn q�or affirm d)and subscribed before me of ✓ Physical Presence of Online Notarization i
this day of b� 20i�y i
Name of person making statement.
Perso ly own '�OR Produced Identification
Type f Ide ification Produced
(Signature if ida) '
f Commission84a1)
REVIEWS fj•'••pfrblkU• �G SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
IEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
COMPLETED
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1071'2721-
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