HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: REC�IVEO Permit Number: a�-' • [ �_
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_.. : - bilding Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL j4982
Phone: (772) 46245S3 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Property Tax ID#: ✓—1 � l��(��'—� ���dV� (j " Lot No.
Site Plan Name: Block No.
Project Name:
YY
Lerzin es or t M
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:$ 1000 Utilities: ._Sewer' Septic Building Height:
- �� w d
6wvc' N _
Name 'Name: P - -
Address:
nr P o 2 �C'�• Company: P (1 Ct!r-47 cw1
City: Of� fJ��CC' State: FL Address: Stiy n 14VIO
Zip Coder Fax: City: S J c State: _:i�L
Phone No. Z q E-' Zip Code: cf.�S�� Fax:
Mail: 0 ! Phone No 2
Fill in fee simple Title Holder on next page (if different E-Mail i 1 P F C AA bl C 6AI)
from the Owner listed above) State or County License-- l 0o' CA4zl 07C4
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: P�
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 AFFID.VIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 Twill,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
WARNING30 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 len er or an attorney b f re commencing work or reco.rdin our Notice of Commencement.
(ignign'avture of Contra for-or-Owner Builder as applicable
STATE OF FLORIDA -Siff
COUNTY OF I(Ju A" �=
Sworn jo(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this/ day of Aeo? 202!ny ;
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced fE Cam. 1�
VV -
(Signature of.Notary Public-Sta e o 1 ' -state VAUGHN tate of Florida-Notary Public
ac Commission #
Commission No. ( � MY commission Exp�e$9
�F FIOQ�
22, 2022
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DATE
RECEIVED'
DATE `
COMPLETED
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