HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPC'-�D FOR APPLICATION TO BE ACCEPTED
Date:—�-���� hermit Number: C '
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Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
RECEIVED
Building Permit A plicata®n
..Luc;e County
Permitt 'g
Residential
JAN 2 7 2022
Address: 6 03 Sho-OK)m DY-Wy e
Property Tax ID 4: V 3b1- to 13- 0 364 - 0004 Lot No.
Ivew Lieci_ricai iVieUer JCLUI1u 1
Additional work to be performed under this permit - check all that apply:
Mechanical Gas Tank —Gas Piping _ Shutters
Electric Plumbing _ Sprinklers _ Generator
K
Windows/Doors Pond
Roof Pitch
Total Sq. Ft of Construction: Zvi Sq. Ft' of First Floor: Z
Cost of Construction: $ 7A00 .vn Utilities: _Sewer _Septic Building Height:
Name ►
r I_. V J17
Address:
1 U3 s 11110_n (� '
City: /Lace- State: i�
Zip Code: 01 Fax:
Phone No. -1-7d-' oQL/q-1q 0
E-Mail:
W 160 88L (D
f✓f!I_[ SIG
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address: -
city.
Zip Code:
Phone No
E-Mail
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.
Fax:
State:
DESIGNER/ENGINEER:
Not ApplicableMORTGAGE 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
which is in conflict with any applicable Home
is granting a permit will authorize the permit holder to build the subject structure
Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners
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
com.mencing work or recording our Notice of Commencement.
Art.
Signature of Owne-r/ Lessee/Contractor as
STATE OF FLORID
Agent for Owner
COUNTY OF
Sworp,�q (or aff' ed) and subscribed before
me of Physical Presence or Online Notarization
this dday f , 2
0 ' w a yc [9L-qZ
by
Name of person making statemen -
Personally Known OR ed Identification
Type of Identification Produced
(Signature of Notary P ic- State of Florida
)
o ssv?�ov.; AUDREY B. HUMPHREY ?
Commission No. (Seal)
=?' ° = MY COMMISSION#GG300817 n
*:
EXPIRES: March 6, 2023 i
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Bonded Thor Notary Public Undervrritar"
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Rev S 2 21