HomeMy WebLinkAboutBuilding Permit Application d�
MUST TED
BE COMPLETED FOR APPLICATION TO BE PerEP 5I1
mit
All APPLICABLE INFO Number: RECEIVED
F EB 2 � 2022
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Building P��mit pple�a�i�� emittng
Residential
Planning and Development Services Commercial
Building and code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34962.157g CBDG Funding
Phone: (772) 462-1553 Fax: (772)
PERMIT APPLICATION FOR _
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Lot No.
Address 3ea�d3_bbo' Block No. .�
Property Tax ID#:
Site Plan Name: ag WON �
Project Name:
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work to be
ermit—check all that apply: Pond
performed under this p Shutters _Windows/Doors —
Additionalas Piping —
Gas Tank —G Roof Pitch
_Mechanical — Generator, —
Plumbing _Sprinklers —
Electric — Floor: I
Sq. Ft. of First /
of Construction: Septic Building Height:Total Sq. Ft -Q Utilities: Sewer
Cost of Construction $ _ '� � � R
Name
»ame
I Address: State.s1 Address: State:
City: �! v C.� City:
(, Ci ' 1 Fax: Fax:
Zip Code: E_ Zip Code:
Phone NkIlln Phone No
���� r1C�.�el !
Mail` ) _ E-Mail
Fill in fee simple Title Holder on next page (if different
State or County License
from the Owner listed above)
if value of construction is 2500 or more,a RECORDED Notice of Commencementis required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required,
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DESIGN ER%ENGINEER- _ Not Applicable MORTGAGE COMPANY: W 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 or an attorney before commencing work or recording our Notice of Commencement.
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` ignature or or-Owner Bu er alsaplicable
STATE LORI A
COUNTY OF
Sworn to(or affirmed) and subscribed before me of Physical Presence or Online Notarization
I this a'A day op� , 20Wa.by
Lavi�t5 �.y�11q
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced ��►'Q�-
(Signature of Notary P II - DEANNAGIVEyS
t� Public State of Florida
Commission No. d `(S�� mmission a NH 096359 '
µy Comm.Expires Jar 28,2025
'''�ogF• Nationai',otary Assn.
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