HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE C� __'LETED FOR APPLICATION TO BE ACCEPTs,_s�
Date: \_ Permit Number: ®�
fl 0 t1�f� R RECEIVED
_....,.- o..:"` MAR 0 7 2022
Building Permit Application sf.,Luciecounty
Planning and Development Services Permitting
Building and Code Regulation Division Commercial Residential -y'
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address:
Property Tax ID #:
Site Plan Na
Project Name:
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4-IZ5I1 e-+ 13 0o
I?M `+✓yL-c— ,
New Electrical Meter /v Second Electrical Meter (/� (Affidavit required)
Lot No.9%0 _
Block No.
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: %b b Or Sq. Ft. of First Floor: y o S�
Cost of Con sON;O0 0,G .tJon+�-1 Utilities: _Sewer _Septic Building Height:
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Name
Name:
Address:% ! a-em 7119��
Company:
City: --1 -t� State: j L
Zip Code: Fax:
Phone No. E-
Address:
City: State:
Zip Code: Fax:
Phone No
Mail: P r effn\
Fill in fees ple Title Hold'et on next page (if different
from the Owner listed above)
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.
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY: 'IClot Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
V Not Applicable
BONDING COMPANY: _A,,Wot 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 Ipnrlar nr an attnrnpv before cnmmencina work or recording vour Notice of Commencement.
Si natu f Contr for - or - Owner Buil(Ar as applicable
STATE OF FLORIDA r
COUNTY OF
Sw to or affirmed) ands bscribed before me of
Physical Presence or Online Notarization
day of 20y
Name of per on making statement.
Personally Known OR Produred Identification
Type of I ntification Pr uced L
(Signature of Notary Public- State of Florida)
KAREN S. NIELSEN
Commission No. (Seal) `�o,P B<<;State
of Florida -Notary Public
-* *_
Commission # GG 207484
fOFe•o:`
My Commission Expires
June. 12, 2022
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