HomeMy WebLinkAboutBuilding Application— ,-
All APPLICAPLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
a a Permit Number:\\�o1W a.
Date: RECEIVED
�4o C�C�DG �_Arj NOV 12 2021
o ,,, • -, ._ o • ; St. Lucie County
- Building Permit Application Permitting
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
Residential
PERMIT APPLICATION FOR:
5P`ROPOSED hMPROUE(VIENT LOCATION
� Address: �3`�\\_� , �% ��.N,N
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION 'OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION.
Lot N0.1`3V \\
Block No.
Additional work to be performed under this permit- check all that apply:
(Mechanical /Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
ZElectric � Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ O�Z C)
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNEK/LESSEE
CONTRACTOR:
Name �c1 r�r�\ �CC� RQ `.,awl
Address Q.0_S , 7-)��
Name: `cc >��M �1 C�c�c� 2S
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Company:
City: Stated\y
Address:
Zip Code: \��\�`a Fax: 1
City: '-4c
State:_S_7_L—
Phone No. N
Zip Code: Fax:
E-Mail: -
Phone No `1'-i i- a Dli-
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Fill in fee simple Title Holder on next page ( if different
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State or County License MQ_c-'
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from the Owner listed above)
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.
MENTAL CONS1 RUCTION LIEN LAW INFORMATION
lER/ENGINEER:- _ Not Applicable
MORTGAGE COMPANY: Not Applicable
�ca`c�se� ��o meaS
_
Name:
Address:
State: IR:,'L-
Zip: ZL\b iS Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 dothe 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 attorney before commencing work or recording our Notice of Commencement.
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Signature of O ner/ L see/ ontracto s ent for Owner
Signature of Cont ctor/License Holder
STATE FLORIDA
CO OF f-k
STATE OF FLORIDA
COUNTY OF
Sw9m to (or affirmed) and subscribed before me of
1/ hysical Presence or Online Notarization
this day of , 2024 by
Swor�-to (or affirmed) and subscribed before me of
✓ Physical Presence or Online Notarization
this � day of _ 2024 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced`
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No.
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