HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:T`'�� Permit Number: �'��'
05T. WTOLIE RECEIVED
o� JAN 26 2022
Building Permit Application St.,Lucie County
Planning and Development Services Perimittingg
Building and Code Regulation Division Commercial Residential . ✓ `
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: aa� �ral
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Address:
Property Tax ID#: G Lot No.
Site Plan Name: ; ,
Project Name:
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110 -
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20 E
New Electrical Meter Second Electrical Meter (Affidavit required)
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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: p Sq. Ft. of First Floor:
Cost of Construction:-$ —71 0 Utilities: _Sewer _Septic Building Height:
'12
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Name Name:
Address: 1L— Company - LDS
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City:U State: Address.- Cam.
Zip CodeVk5�cqg Fax: City: State:
Phone No. E- Zip Code'H<51 Fax:
Mail: Phone No "17
Fill in fee simple Title Holder on next page (if different E-Mailr'�JC
from the Owner listed above) State or County Licens g;-,�_" `'? 1
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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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address:. Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE BOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
j 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 conflicts with any 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 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.
Signature of Contractor-or-,OwnLA Builder as applicable
STATE OF FLORIDA
COUNTY OF S-'. Lode
Sworn to(or affirmed) and subscribed before me of Physical Presence or Online Notarization
thisa64 day of_5aly,,,_ 203aby
\\ 1 <• :A `c _V4
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced T"L tp'`
(Signature of Notary ublic-Sta e
OEMNA GNBN5
Commission No ,Y...,.. �c pia tate of Flonoa
CornmIsstion t HH G86352p25
A' Comm.Expires Jan 2f! Assn.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
'COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 10/12/21