HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE C(7nn�LETED FOR APPLICATION TO BE ACCEPti'w" +�
Date: 2- 23- 22 Permit Number: &-alo Q (0 l
99. LUCE '�` RECEIVED
Y'° ` Building Permit Application FEB 2 3 2022
Planning and Development Services St. Lucie County
Permitting
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: Coo cj e_�C_ � la1p
PRFOSE� IMPROWEMNT LOCAT)ON A = P
Address: Bqc X(n f�''t11e- e— 1 35gC rz
Property Tax ID #: 21HO Z• (Qn9- 1 `-id - Occ-"5 Lot No.2_
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit -check all that apply:
_Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ . 2 .. tic_)o
Gas Piping
_ Sprinklers
Block No. 5A
(Affidavit required)
_ Shutters _ Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name R(9P_1;0 2W0_O(Aye_S
Address: , 90?_ TAlm D-(
City: k V ic� c e State:
Zip Code: Fax:
Phone No. 712-- 325- 533 1 E-
Mail: cx.11e.1 i o ig \/a hnn . rn✓+'l
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 Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
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 attornev before commencing work or recording vour Notice of Commencement.
�� 44�
ignature of Contractor - or - Owner Builder as applicable
1
STATE OF FLO I A
COUNTY OF \ Ua, IL
Sworn o or affir and subscribed befo me of
Physical Presence or Online Notarization
th' day of , 2y
Name of p6fson making statement.
Personally Known OR Prod Id ntification
KAREN S. NIELSP
Type of Identification Produced
, Public
PUO !�
state of Florida Notary
``OiPPY
_; h= Commission # GG 207484
= Expires
o M Commission
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
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Rev 10/12/21