HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO. BE ACCEPTED
Date: �- a3�1 Permit Number: °1��a.� 111
FdECEIVED
o l�l�l DEC 23 2021
Building Permit Application
St. Lucie County
Planning and Development Services Permitting
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:
Address: ,71
Property Tax ID #:
Site Plan Name:
Project Name: I
New Electrical Meter Second Electrical Meter
(Affidavit required)
Additional work to be performed under this permit— check all that apply: r. /
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors . _ Pond
_ Electric _ Plumbing _Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: / 7 Sq. Ft. of First Floor:
Cost of Construction: $OUtilities: _ Sewer _ Septic Building Height:
Lot No.
Block No.
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Name O
Name:: .
Address: b d
Company:
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City: rter"e,-VState:
Zip Code: Fax:
Phone No. _ 5 E-
Address;: _ �„ '
City: n 7
Zip Code:
Phone No —
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Fax:
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State:
Mail:
Fill in fee simple Title liolder on next page (if different
from the Owner listed above)
E-Mail ccir�17
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State or County Li ense : `
023 W3
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE -COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip:
State:
Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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
ith lender or an attorney before commencing work or recording our Notice of Commencement.
i u of Owner/ Lessee/Co a as Agent for Owner
ST E OF FLOR DA
COUNTY OF 1 \.Jc�
Sworn to (or affirm ) and subscribed before me of Physical Presence or Online Notarization
this day of q-L 20bA by
w--StR'�n�
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced KL- lb k_
(Signature of Notar ublic- State of Florida)
Commission NoAA (Seal) DEAN .caaeofFloclda
°G' public' Ofs6359
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Notary H
Commission H 8.2025
Expires k µotarY
MY National Assn.
OF tau
Bonded
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21