HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Ol�o
RECEIVED
h1 U MAR 0 4'2022
Building Permit Application
at,.Lucie county
Planning and Development Services Permitting
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
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Property Tax ID #: 211 _ 9 b � - bo l'� - fQG� ' Lot No. 19
Site Plan Name: 13 Block No.
Project Name: Btuys Mei;m, ou-yib'4
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit -check all that apply:
_Mechanical — Gas Tank — Gas Piping _ Shutters _ Windows/Doors T Pond
— Electric _ Plumbing — Sprinklers — Generator ^ Roof Pitch
Total Sq. Ft of Construction: 120p Sq. Ft. of First Floor: 12-60
Cost of Construction: $ 51 �� Utilities: _ Sewer _ Septic Building Height: 1 10 I6 it
�O,WNER�/LEEE>1��C®I
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�ACTOR�3��
Name MIG -
Name: i
C any:
Address: I $COZ b1ZI VL9 , AY
City: paRr dr;,T, Loat,- State: FL.
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Zip Code: °� Fax:
City: T L
Phone No. �� 2 �d n Io°�� i
ode: ax:
E-Mail: Mbl dDw%
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Fill in fee simple Title Holder on next page ( if different
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from the Owner listed above)
S e or ounty L'
If value of construction is Z500 or more, a RECORDED Notice of Commencement required. 'J
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
OWN-
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applidable_
Name: -Name: — ..
Address: Address: -• -
City: state t City: "`; Sate
Zip: Phone 1Zlp ' Phone:
FEE SIMPLE TITLE BOLDER: _ Not Applicable -BONDING COMPANY: _Not Applicable
Name,: - Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
3
OWNER/ CONTRACTOR AFFIDVIT Applicatipn is hereby madeagobtain a _permit to do -the work and installation as s indicated.-
I certify that no work or Installation has commericed 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-orandcovenants 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 reques`ted� i - iif, 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 strbctuYes, swimming pool's; felCes, walls, signs, scre6r! rooms and accessory uses to another nonresidential use
WARNING T ' OWNER': Your failure to Record a Notice, pf,,,Comriiericementmat' result in paying tWica.for
improvements to your_propbrty',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-commencingwork or recording our Notice of Commencement..
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Signatu e f Contractor -'or
-.Owner Builder as applicable
STATE .OF FLORID
COUNTY OF � _ .�
Sworryto (or affirm d) an subscribed bef�o[e me of
J4__ day
Physical Presence or Online
Notarization
this of 20=kllby
Name of person making statement.
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Personally Known OR Produc Id ti ication .�
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Type of Id1=ntification Pro uced
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