HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Permit Number:
Date: J
RECEIVED
T �.. Building Permit Application FEB IS 20 1
Planning and Development Services St.Lucie Coun
Permiti
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:
FR'OPOSED IMPROVEMENTLOCATION:_'
Address• q I Y ( i c
Property Tax ID#:%3,A� � ��� ���5 —�X� .T "� Lot No
Site Plan Name: Block o.
Project Name: I
DETAILED`DfSCRIPTION OF WORK:
New Electrical 1eter Second Electrical Meter (Affidavit required)
;CONSTRUCTION:INFORMATION.: . -
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 J�r Pgch,U"cc§c
Total Sq. Ft of Construction: Sq. Ft. of First Floor: �\
Cost of Construction: $ d ' Utilities: —Sewer —Septic Building Height: c�
OWNER/LESSEE CONTRACTOR:
Name Name:
Addr ss• _ M e—C Company:
City. 0( P State: Address:
Zip Code:3y'!8 Fax: City: State:
Phone No.)w -����o `'509 E- Zip Code: Fax:
Mail:V3 L)C 6, .C0C>1 Phone No
Fill in fee i ple Title Holder on next 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.
IN
SUPPLEMENTAL CONSTRUCTION LIEN LAW°INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Ap ilicable
Name: Name:
Address: Address:
City: State: City: State.
Zip: Phone Zip: Phone: _
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
licable
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 installatio 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 subje structure
which conflicts with any applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohi it such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may app y.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the wor
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-residenti I use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in paying twice f r
improvements to your property. A Notice of Commencement must be recorded in the public r� cords of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain finanh ing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Contractor-or-Owner guilder as applicable
STATE OF FLORIDA
COUNTY OF
Swor (or affirmejd40d sp bscribed befo a of Physical Presence or Online Notarization
this day of 2Q��
Name of person making statement.
Personally Known OR Pro d Ide ific�tion
Type of Identification Produced C
—��4AJ AA I -,I
(Signature of Notary Pu lic-Wte o Florida)
Commission No. (Seal) `tiPpYP�ei KAREN S. NIELSEN
`20 <<;-:State of Florida-Notary Public
_. Commission # GG 207484
=9, p;F My Commission Expires
June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE TANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21
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