HomeMy WebLinkAboutBuiding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Y V `` �1
Date: Permit Number: !/`y .y)
59 -'J . LLCt1L ``"` t 1 ' 1®q �� RECEIVED
O
LF'` Building Permit Application SEP 2 0 2021
Planning and Development Services 8t Lucie County
Building and Code Regulation Division Commercial Residential Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
I:: P?RO;POSE04MPROVE MENT.LOCAT(ON .: ° .
Address: '/Y(g X UAL (LATOa (tom (a b
PropertyTax ID #: 3 ZZ 9 " 60a — t)0.1�3 — p_p o " a- Lot No.
Site Plan Name �G R Block No.
Project Name: /*IJ �--
New Electrical Meter
11PT10N. OF WORK::
Second Electrical Meter (Affidavit required)
CONSTRUCTION 'INFORMATION:
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: _ UT, 0" DO Sq. Ft. of First Floor: _
Cost of Construction: $ UU` Nft�� . 1_1.t.'in J Utilities: _Sewer _Septic
Building Height:
OWNER%LESSEE:. . _
_ _- _
CONTRACTOR.
s
Name
Name:
Address: I6 JJ %qt--)
Company:
City:
Address:
Zip Code: `f g Sy Fax:
City: State:
Phone No. 7 2 44, ' L a 5 E-
Zip Code: Fax:
Mail: A),4 i ev, ahoo. Cry— °
Phone No
Fill in fee simple Title Holder on n xt 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.
SUPPLEMENTAL CONSTRUCTION':LI,EN I AW=INFORM TION' :... .
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: Stater
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 grantip 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 consu t 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-attornev before commencine work or recordine vour Notice of Commencement_
Sig nat of Owner/ L ee/Contr or as Agent for Own
STATE OF FLORIDA
COUNTY OF Luz-7,-e,
Sworn to (or affirmed) and subscribed be re me of
Physical Presence or. Online Notarization
this -Uday of 2014 by
Name of person making statement.
Personally Known OR ProducAldentification
Type of Identification Produced U
(Si nature of Notary Public- tate of Florida)
Commission No. (Seal)
tPN U i
�``"YP'a�, HEATHER BURFORD
State of Florida -Notary Public
=' �= Commission # GG 183217
My Commission Expires
February 06, 2022
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