HomeMy WebLinkAboutBuilding Permit App All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Date: Permit Number: Qa.03- .4
RECEIVED
o MAR 2'3 2022
MT
Building Permit Application
St..Lucie County
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 CBDG Funding
PERMIT APPLICATION FOR:
Address:
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required)
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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 _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1 Utilities: —Sewer _Septic Building Height:
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Name Name:
Addres -P mpany:
City: (t State: �/ Address:
Zip Code: 7 Fax: City: State:
Phone No. O — A1 E- Zip Code: Fax:
Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
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.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State-
Zip: Y
Phone Zip: Phone:h p e.
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 represer€tation that is-granting a permit will authorize the permit holder to build thesubject structure
which conflicts with any applicable Homeowners Association rules bylaws or and covenants that may restrict or rohibit 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 Coun and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lend an attorney.before commencing-work or recording our Notice of Commencement.
Si nature o tractor-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF_ /
Swor (or affirmed)and su scribed befor me of ` Physical Presence or . Online Notarization
this day of 20�y
Ct,PtOnS MzINSo
Name of person making statement.
Personally Known OR Prodded Iden • ication
Type of Identification PYo uced
(Signature of Notary Public-State of Florida) .
Commission No. (Seal) " KAREN-S. NIELi:_!`i�
CgPPY pyli ii
,_ _;State of Florida-Notary Puoli
_* *= commission # GG 20743G
My Commission `.xpires
'mma` June 12, 2022
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