HomeMy WebLinkAboutBuilding Permit Application-CHG TO OWNER BLDR All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
RECEIVEDDate: ,I Permit Number: 1( Wf::
APR A 2022
St.Lucie County
Permitting
° - Building Permit Application
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
PERMIT APPLICATION FOR:
I,
PRO110,05D b PROUEME T LOCATION:
Address: I Iffle
Property Tax ID#: I (7��'� Y3!! 00 Lot No.
Site Plan Name: Block No.
I
Project Name:
D 9TAILED DESC*RIPTCON U WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CO STRUCTION IN'F0 ' �ATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gasstank _Gas Piping _Shutters Windows/Doors - -.Pond j
Electric _Plumbing _Sprinklers _Generator _Roof Pitch 1
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 4fijl" voo Utilities: . _Sewer Septic Building Height:
O NER/L 1 CON W 3IUW0
Name Name:
'Address:LL,� Company:
City: fy/_ /-�: State:_ Address: ..
Zip Code: 3 �'9 5 1 Fax: City: State:
Phone No. E- Zip Code: Fax: I
Mail: Ok& Phone No
Fill in fee simple Title Holderpn next page(if different E-Mail
from the Owner listed above) ate or.County License
Yieri E )R13 �y
ifts.
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If value of construction is 2500 or more,a RECORDED tice of Commencement is req it .
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
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&MPLEMENTAMMINNESER,tWARROAMIENS 11A.010,iFORMATION:
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 covenaffits'that"may restrict or prohibit such
structure.Please consult with your Homeowners Association and review-ycur•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
i'mprovements 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 attorneybefore commencingwork or recordingour Notice of Commencement.
Signature of Contractor-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this day of 2
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced ���_
(Signature of Notary Pu eazlsi
`s;;P�e, ELLEN VAUGHN
Commission No. ;r° `�rSec�nte of Florida-Notary Public
Commission # GG 270079
My Commission Expires
_Q�tQhr_.n_2D.22
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