HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit•Number:
RECEIVED
MAR 16 2022
Building Permit Application St. Lucie County
Perm
i in
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
FPRM IT APPLICATION FOR: � I M1 WWS
Address: 31 1 '50,4rJ5TDSJ nM� C '�t Prr�1 CC r� 3`4
Property Tax ID #: 34o!, - 502-- 005 7--(= ` Lot No._
Site Plan Name: Block No.
Project Name: EGC nl" 0
New Electrical Meter Second Electrical Meter (Affidavit required) 5
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ ShuttersWindows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Constructio.
Cost of Construction: $V-6-0a
Sq. Ft. of First Floor:.
Utilities: _ Sewer _ Septic Building Height:
Pond
Pitch
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OWN
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Name �
n...
Name:
-
Company::
.
City: State: FL
Zip Code: C1 S2 Fax:
Phone No. 7— Z ek 70 E-
Address;
City: ^� - _
Zip Code:
pro>la�
Fax:
State:
Mail: S L
Fill in fee simple Title Holder 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 or commencement is requires. I
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:.
Address:
City: State:
Zip: Phone
City:, State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:. Not Applicable
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 nb representation that is -,granting a permit.wilk, uthorize:the pe•'rmitrholde'r-to,build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws.or and'covenahts that may restrict or prohibit such
structure. Please consult with your Homeowners Association and, review ypur 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 concurrencyrr,eview:,room addition`s,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessoryi.ises to another"nori=residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements o ou roperty. A Notice of Commencement must be recorded in the public records of St.
Lucie County • n p ed on the jobsite before the�•fi,rst inspectionAf you intend to obtain-financing,.'consult
with lender ' r"" ornev before commencine'wo`'rk or recordinevour Nofice`of Comr7ierirement-
Signature o on ctor - - Owner Builder as applicable
STATE OF ORIDA
COUNTY OF 5-�.
Swor to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of'hw4 20k't— by
G. +N,n o; t 6
Name of person making statement.
Personally Known OR Produced Identification
Type Identification Produced
\o)f
4'
(Signature of Notary ublic- State of Florida)
Commission No. �t S (S�NNAGIVENS
ary Pub • State of=:orida
Commission # HH 086359
off
of �... My Comm. Expires Jar 28, 2025
$.
Bonded through National Notary Assn;
_
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