HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u u
Date: 2 Permit Number�aaa```
M[� RECEIVED
Q FEB 16 2022
Building Permit Application St. Lucie County
Planning and Development Services f39rrflliEli
Building and Code Regulation Division Commercial Residential /
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
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PERMIT APPLICATION FOR: �a
MR,
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Address: jG /
Property Tax ID #:
Site Plan Name:
Project Name:
New Electrical Meter
Second Electrical Meter
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Lot No.�
Block No.
required)
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: Sq. Ft. of First Floor:
�_ Cost of Construction: $ �sUtilities: _ Sewer _ Septic
Jows/Doors _ Pond
Roof Pitch
Building Height:
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Name 0,A1
Name
Company
Address
City:
Zip Code:
Phone No
E-Mail
State or County
Address:%G%O/
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City: j Pf�S�/�/C !� State:�L •
Zip Code: :?--/25-Z Fax:
Phone No. G% �— 5� ZC'/� E-
State:
Fax:
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Mail:, vQ.SZCCO CC'1
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
License
I If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. I
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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MORTGAGE COMPANY:
�°F r
Not Applicable
DESIGNER/ENGINEER: _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 oran attorney before commencing work or recording our Notice of Commencement
Be u o Contractor wrier uilder as applicable
STATE OF FLORIDA
COUNTY OF 6k.
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day �+
j16 _ of 2014' by
Name of person making statement.
Personally Known OR Produce Identification
Type of Identification Produced
(Signature of Nota Public- Sta e f F o '.
DEMNA GIVENS
Commission No. PAL-apjtate of Florida
•
y c Commission 9 HH 086359
My Comm. Expires Jan 28, 2025
oFrti
Bonded through National Notary Assn.
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