HomeMy WebLinkAboutBuilding Permit Application 1
All APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: aa�1�d�aa
RECEIVED
o� JAN 2 6 2022
Building Permit Application St.Lucie County
Permitting
Planning and Development Services
Building and Code Regulation Division Commercial Residential XX
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: ROOF -
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PRO POSED71MPROVEIVIENT LOCATITOiV � r
Address: ��� L!//�Z �!� • 17�f,P�� �• ��..Q
Property Tax ID#: ;34 03 — Sot ^ of 3l r (;)00 (P Lot No.
Site Plan Name: Block No.
Project Name:
DETAI'L'ED DESCRIPTION''OF VVO'RK
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New Electrical Meter Second Electrical Meter
CONSTRl1�TIONINFO'R�M�ATI�O'N�� ���� � ` � � � � ��� ��� ���� �����
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: � Sq. Ft. of First Floor:
Cost of Construction: $ i i U Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE tCONTRA� ®R
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Name SQ11wi6or 5 Name:
Address:��Sf�l�/TZ �70 Company:
City: 99[oy—CE State: Address:
Zip Code: Fax:rr City: State:
Phone No.��U � /�� Zip Code: Fax:
E-Mail: 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.
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SUPPLHMENTAL C®NSl R+.UCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable 1
Name: Name:
Address: Address:
City: State: City: State:
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 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
impro ements to your property. A Notice of Commencement must be recorded in the public records of St.
Luciglounty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wit nd r or an attorney bef re commencing work or recording our Notice of Commencement.
4
Signature of Owner essee n r ctor as-466nt for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF-ST LUCIE CO U NTY OF ST LUCIE
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
xx Physical Presence or Online Notarization xx Physical Presence or Online Notarization
this rrbay of 3"q r1uC f(r 202@Pby this day of 2020 by
Name of person making statement. Name of person making statement.
Personally Known xx Personally Known xx OR Produced Identification
Type of Identification fir, La ryPub ieg��aF� Type of Identification
Produced Castro Produced
ar w Expiree 06/m 2022 218338
(Signature of Not rS F (Signature of Notary Public-State of Florida)
Notary Public �{
Commission No. '� a ld.M. earl FWwa Commission No. (Seal)
T My CommissiV GO 218338
cW Expires oe/2412022
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