HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: -Sl al,3. Permit-Number:
RECEIVED
o`s MAR 3 0 2022
Building Permit Application
Si:Lucie County
Planning and Development Services Perrnitting
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:
Address:��• 5 �� S �-� �� �;yc p
Pro perty Tax ID#: �yaa3 'd� OvF Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required) 1L,� cruse, I
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Additional work to be performed under this permit-check all that apply:
—Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
Electric Plumbing _Spri.nklers —Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 3eDno Utilities: —Sewer —Septic Building Height:
107
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Name 0 y, e Name:
Address:s� y�� Sf y Company:
City: CAS 1 2-,C C State: f ; Address: j
I Zip Code: 9 Fax: City: State:
Phone No. Z - �/ I �- -7 0 Z E- Zip Code: Fax:
Mail: 'S b S P C2� yl y' l0O, C OA, Phone No j
Fill.in fee simple Title bolder on next page (if different E-Mail
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from the Omer 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$7500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _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 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.
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 recordirfg your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA i
COUNTY OF I
Sworn to(or affirmed) an su scribed bef9�r me of =Physical Presence or Online Notarization
this t day of 20d' by
Name person ng state ent. o
Personally Known OR Produced Identification
Type of Identifi ation Produced
(Signature of Notary Publ -State of Florida)
Commission No. (Seal) i. `. :'s` ':.
_ <r�. (;b'C^itiiuliSS'r N if uG 3D0817
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P;RES:March o,262"s
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE .
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2 21