HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONk.PPLICABLE INFO MUST BE COMP'-'-.--D FOR APPLICATION TO BE ACCEPTED
Date: X a+ Permit Number:
RECCZIVE5
- -� JA N 19 2022
0 L�' Building Permit Application ry
St. Lucie Coun
- Planning and Development Services Permitting
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: od1
41?RQPOSED IMPROUE,ME'NT L`,OCATION, ct
Address: 2ODCO'ALr
Property Tax ID #: Ct} S,ADM—Dp3 -cm- I- Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION `OF WORK
Ngw El?gtriggl Meter Second €lectricul Meter (Affidavit required)
CONSTRUCTfON INFORMATION .
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: �rv�
Cost of Construction: $ �� r
Generator
— Windows/Doors — Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE ;.`
CONTRACTOR:`
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Address:
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City: :r;: As. 1 g fce- State:(
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Zip Code: 3 r,L( Fax:
Phone NG�1)k 5-
E-Mail n
Fill in fee simple Title Holder on next page (if different
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.
"U`PPLEMENTAL
CONSTRUCTION
LIEN LAW INFORMATION
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address: a
'r
Address:
City: V' S&n cle In
State:
City:
State:
Zip: '--Q1)Le Phon&-02l
-ZJoQ - Q 1
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 certifV 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 is in conflict with any'applicable Home 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.
Th€ fQilowing Wilding permit applit;ations iare exemet from undgrgQing a full rpnrurrensy review: rppm 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 your Notice of Commencement.
r_l� z
STATE OE/FLOR
COUNTY OF , La C,, 1
Swor4o (or affirmed) and subscribed before me of '-�hysical Presence or Online Notarization
this day of�CaN_4reif_E( . 20_Wby
Name o person makings ent.
Personally Know Produced Identification
dentif' ation Produced
(Signature Notary Public- St of Florida)
Ekofj
tary Public State of Flcr�aCommission No. (Seal) nyel Jones Commission GG 3520
pires 07/0412023 1,
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