HomeMy WebLinkAboutBuilding Permit Application�I
All APPLICABLE INFO MUST BE Cc, °:.1LETED FOR APPLICATION TO BE ACCEP'rru
Date: er it Number:
ECEIVED
NOV 17 2021
Building Permit Application
Planning and Development Services ST. Luci C nty, 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:. i �0�'hz.Xcw
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ePFopse� Ta `fl #:
Site Plan Name:
Project Name:
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Electrical Meter Second Electrical Meter
(Affidavit required)
Lot No.
Block No.
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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
X Electric XPlumbing _ Sprinklers _ Generator . _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
os of"Gonrucfion $ Utilities: —Sewer _.Septic Building Height:
yarn
GC)NTRi4CT R.
,WNERLESS.- �....�
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Name o(.
'Name: Qr iv-Pecj
ddress:
Company:
City: t' State:
Zip Code: 63S— Fax:
,Address:
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„Phone No. (p� (o oi5.��0
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Z p Code: 63 �C I ax:
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Mail:
Fill in fee simple Title Holder on next page ( if different
E''Mail
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 APOOIlcab�
Name:
s^"
MI0RT,GA
Address:
J
COMPANY:
Not Applicable
Address:
City:
Zip:
I
State:
Phone
I
City:
Zip:
Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: I
City: I
Zip: Phone: I
BONDING COMPANY:
Name:
_Not Applicable
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT'Appl'ication 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 holderto build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association, and reviewyour 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 FI rida 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. Al 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 commencing work or recording your Notice of "Commencement.
5lgnatwe=ot-contractor - o caner butlaerlas appii
STATE OF FLORIDA COUNTY OF q.
Sworn t (or affir a and subscribed befor me of
this " day of 20 by
Name of
Personally- Known OR Produced Identification
Type of Identification roduced A I n
\ I.
Notary PuMc- State —of Florida )
Commission No.
e
Physical Presence or
Online Notarization
KAREN S. NIELSEN
?a° State of Florida -Notary Publi
=' *= Commission # GG 207484
My Commission Expires
June 12, 2022
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