HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit, Number :N
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Building Permit Application MAR 021122
Planning and Development Services St. Lucie County
Perm,,,,,, �
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:
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Address: t 1 -7 L„.Aw!s d i�bre 2
Property Tax ID #: ®0 00 :10) Lot No. �4
Site Plan Name: CF!a,&
Project Name: Nz4r:_::�
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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:
Gas Tank Gas Piping Sq"uu ters Windows/Doors Pond
_Mechanical _ _ _ _
_ Electric _ Plumbing _ Sprinklers _ Generator 'L/Roof `'ZTritch
Total Sq. Ft of Construction: kSC3 0 Sq. Ft. of First Floor:
Cost of Construction: $ `% ® d� Utilities: —Sewer —Septic Building Height: �r
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Zip Code Fax:
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Phone No. E-
Zip Code:7�A,!�q 0 Fax:
Mail:
Phone No ' 7-7'Z `17 -4 q '-'
E-Mail St .,—; ✓1 �(i? �� Z�-
Fill in fee simple Title Holder on next page (if different
State or County License
from the Owner listed above)
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.
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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 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; your Notice of Commencement.
Signature of C ntractor - or - Owner Builder as applicable
STATE OF FLORID
COUNTY OF 1 �C�t
Sworn t_9 (or affirmed) and bscribed befor me of Physical Presence or Online Notarization
thi of 20OT4y
Name of person m king statement
Personally Known OR PrndLwed Id tification
e of Id ntification Pr uced
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(Signature of Notary Public- State o Florida)
Commission No. (Seal)
PUBS KAREN S. NIELSEN
\�PpY
°:State of Florida -Notary Public
=* * Commission'# GG 207484
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Rev 10/12721