HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BECOMPLETED.FOR APPLICATION TO BE ACCEPTED
Date: �' O�� Permit Number, c -2
RECEIVED
C bl h� FEB 0 8 2022
Building Permit Application -9t,Luor®cownty
Planning and Development Services Permlttjng
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: �. cq-r i Cke
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Address: _D 6 �� n ' A �� Tier
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PropertyTaxID4: �y �' i0s _loom -000— l' Lot No.
Site Plan Name: Block No.
Project Name:
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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: Sq. Ft. of First Floor:
Cost of Construction: $ ) �ro ®� Utilities: _Sewer Septic Building Height:
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Name rd vck dF i-f CXI Q � Name: 9
Address: 0. 60' �\'C� P&AF— Company:
City:� 1 trr c State: Address:
Zip Code: T q 6 Z Fax: City: State:
Phone No. ff� S 9 r -1 l� � E- Zip Code: Fax:
Mail: D(Lt liarClri Oil I Puawo, Phone No
Fill in fee si (ple Title Holder on ne t 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.
DESIGNER/ENGINEER. _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
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 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.
I
S,
Signature of Contractor-or-Owner Builder as applicable
fSTATE OF FLORIDAZ
COUNTY OF U,
SworU(or affirmed)-andsubscribed beA e me of Physical Presence or Online Notarization
this day of 29�by
Name of person making statement.
Personally Known O uced Identification
Type of Identification Produced .
(Signature o(Notary P c-State of Florida)
Commission No. (Seal) ' {�P� AUDREYB.HUMPHREY
;,of MY COMMISSION, GG 30081
E(PIRES:March 6,2.:i_3
Thru Notary Public
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DATE
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