HomeMy WebLinkAboutBuilding Permit AffidavitAll APPLICABLE INFO MUST BE
�, FOR APPLICATION TO BE ACCEPTED
Date:
ST. LUCIE -
C,OU
F 0 R I D A ---
Planning and Development Services
Permit Number: ...2///
RECEIVED
NOV 0 8 1021
Building Permit Application Permitting Department
St. Lucie County
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: ntw P ooi
PROPOSED IMPROVEMENT LOCATION:
Residential
Address: V630 S. FJrOCYCSnrii+rl Pd. R PIf.rOf-, EL 3HqQ5
Property Tax ID#:13'zo - Sol ' 00(j4- 000 -3 Lot No.,- 12-
Site Plan Name::, �
}} Block No.
T-1 —
Project Name: aY Y I YYl O lfl �� 1 cy-T,( �
I4 DETAILED DESCRIPTION I WORK:.
lux. 32 r ruo peri cons r:r c dtC<
New Electrical Meter Second Electrical Meter
i,CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
(Affidavit required)
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric X Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 1 w o G -� Sq. Ft. of First Floor:
_ Roof Pitch
Cost of Construction: $ JO ► o or) Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE CONTRACTOR.,.=
Na
Address:2` 33 S • 42a •
City: F P 1-C Jf (_f, State: FL..
Zip Code: SPgLIS Fax:
Phone No.-11a' bay - S 141
E-Mai
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
City: State:
Zip Code:
Phone No
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.
Fax:
SUPPIVEMENTAL CONSTRUCTION
LIEN I,AWINFORNiATION
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:l-99S 1nC110 iVCI
IV 3i 3I
Address:
City: Y-C Yc� 1e, Ca C"
State • L
City:
State:
Zip:P=lon Phone•"M-Ag
• Llq
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
,Not Applicable
Name:
Dame:
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 attornev before commencing work or recording your Notice of Commencement.
b-
I Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIQA
COUNTY OF \
Sworn.to or affir d ndl1subscribed befor me of � Ph siFal Presenc or Online Notarization
this, day of I .20 l_k by � a � Q `�Y a�. Rc�
Name of person making statement.
Personally Known �R Produced � 'cation
Type of Identification Produced ����� ���
(Signature of Notary Pt�lic- Stale of f r'oWda )
Commission No.�"���ts �; Q
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%AUBLIC,
111
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DATE
DATE
COMPLETED