HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date'OUku `20n Permit Number: a.;ba-bv\
RECEIVED
WOE
FEB 16 2022
Building p p Permit A ligation St.,LucieCounty
Permitting
Planning and Development Services
Building and Code Regulation Division Commercial R2Sldetltlal
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
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PERMIT APPLICATION FOR:
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Address:2��
PropertyTaxlD#:
Site Plan Name:
`�erce 1'r-L
Lot No._
Block No.
Project Name:
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New Electrical Meter Second Electrical Meter
ffidavit req
Additional work to be performed under this permit —check all that apply -
Mechanical _ Gas Tank _ Gas Piping _ Shutters Win
_Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ IGO
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic
oors Pond
ilding Height:
Pitch
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Name
Name:
Company:
Address:
City:
Zip Code:
Phone No
E-Mail
State or County�License
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Address: `L OS l�l (.15 t,�
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City: C'UO ' e( z State:
Zip Code:' MM 6 Fax:
Phone No. �- �3� 1 bl7 E-
State:
1� Fax:
M a i I M 0S1CA
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. I
If value of HAVC is $7,560 or more, a_RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: J
Name: j
_ Not Applicable
Address:
Address: I I
City..
Zip: Phone
State:
City: I
Zip: Phone:
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State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name: I
Not Applicable
Address:
Address: I
City:
City:
Zip: Phone:
Zip: i Phone:
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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 peIrmit holder t l 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 inI paying twice for
improvements to your property: A Notice of Commencement must 6e 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 lanrlpr nr an attnrnev hefnre commencing work or recording vour Notice of Commencement.
Signature of Contractor - or - Owner B (der as applicable
STATE OF FLORIDA
OF �k Ll1C�e Cuv oA
COUNTY v
Sworn to (or affirm d) and subscribed before me of Physical Presence or Online Notarization
this Vsa day of 20aaby
va,4,-k
Name of person making statement.
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Personally Known O,R Produced Identification
Type of Identification Produced IZ19
°
I
(Signature of NotaYy Public- State of F o
pE,pNNA GIVENS I
'�Y D�'B Notary public -state of Florida
Commission No. 63 = e } #HH086354 +
Commission J
2B, 2025
9
'•9jrpF= My Comm. Expires Jan
National Notary Assn. {
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Bonded through
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DATE
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DATE
COMPLETED
Rev 1U/12/21