HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE C(, LETED FOR APPLICATION TO BE ACCEPTI'_ 1(�°
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Date: Permit Number:'
FEB 0 2 2021
�C o L�l.r. EEP f .. St. Lucie C g0y
L 110) ,7. v' - , Permittin
0 .:+.:-:,._. ai...:.: Building Permit. Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address:
Property
Site Plan Name:
Project Name: _
New Electrical Meter
Second Electrical Meter
(Affidavit required)
Block No.
Additional work to be performed under this permit - check all that apply:
Mechanical Gas Tank _ Gas Piping Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator — Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ �2 ) -LO Q - 00
Sq.'Ft. of First Floor:T �p
Utilities: _ Sewer Septic Building Height:
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Name P �-' Ve,�/
Name:
I�t2
Address:
Company: ;VI�}t/C. !�1/1�1 L �� OWIc� i'1'I�nS
City: 1� C� State: ,
Address: 55,1 124 o
,A.V
Zip Code: 35;1, S Fax:
City: \n I %?0-6C-1'1 State: ,
Phone No. 5 �i- - � _ 2� 3 3,7 E-
Zip Code: �i,�U/� Fax:
Phone No rr�t-i �/S S e / o
Mail:
Fill in fee simple Title Holder on next page (if different
L
E-Mailer*� l�el I 's-Ay �r<o yl�T' F o- C-0'
State or County License
from the Owner listed above)
If value of construction is z5uu or more, a KELUKUitU NO11Ce Of --i" =w-
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable 'MORTGAGE COMPANY:
Name: Name:
Address: Address:
City: Statq': City:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE MOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
BONDING COMPANY:
Name:
Address:
Citv:
Zip: Phone:
OWNER/ CONTRACTOR AFFIbVIT: 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 nor to the issuance of a permit.
St. Lucie County makes no representation that is gra ting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Ass , ciation rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Ass ciation and review your deed for any restrictions which may. apply.
In consideration of the granting of this requested per it, 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 exemp from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, Iigns, 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 Notic 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
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INILII ICIIUCI v1 Oil QLlvlllC
I
cable
Signature of Contractor - or - Owner Builder as appl
STATE OF FLORID
COUNTY OF
Sworn (or affirmed a d subscribed befoc2 me of
Physical Presence or Online Notarization
thi. ay of 20a .
Name of person making statement.
Personally Known 4MR Prod d Ide tifi ati
Type of Identification Produced (J
Dn v
L/ V
FY P"
, tP Uao
;a� ��;State of Florida -Notary Public
=* *_ Commission # GG 270079
My Commission Expires
F 1`011�11 October 22 2022
Si nature of Not Public- State of Florida)
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Commission Nted��WL (Seal)
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