HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
JAN 2 2022
Building Permit Application Permitting Department
Planning and Development Services gt, L-Heie County
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: LA n �'
ON e
New Electrical Meter Second Electrical Meter (Affidavit required)
M
CONSTRUCTION IINIF 'RAT
Additional work to be performed under this permit —check all that apply:
,ZM'echanical — Gas Tank Gas Piping Shutters Windows/Doors Pond
- / Electric v"'P'lumbing Sprinklers — Generator — Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 111s;0,05 Utilities: _L./S/ewer _Septic
Building Height:
CONTRACTOR: TRACTOR.,
Name DM Pt-
Name -
Address:
Company: —10M"S 0
City: A 0', 0 0) A 00 V&tA'
Address: 4�(Oci taq�x
_State:
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State:
Zip Code: Fax:
City. LTU
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Zip Code: tM-71-1a Fax:
Phone No.
Phone No
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Mail:
.
Fill in fee simple Title Holder on next page (if different
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from the Owner listed above)
State or County F License
If value of construction is 25uu or more, a KLLUKULU IM011CM of W-ri"1111WIMCIRIC11% la la4mleww.
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 ap attorney before commencing work or recording our Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORID,&
kNA
COUNTY OF
Sworpxo (or affir nd subscribed before me of Physical Presence or Online Notarization
this It day of 2Q �by
Name of person making statement.
Personally Known OR Produced Identification
f Identification Produced
Notary Public State of Florida
(Signature of NotW Public- State of Florida)
My Commission GG 913
jOfs� Expires 09/7BI2023
Commission No. (Seal)
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Rev 10/1Z/Z1