HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONRBI APPLICABLE IN MUST BE C-
Date: ( l•
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Planning and Development Services
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SCANNED
BY
St Lugfe P%*
Building Permit Application
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
FOR APPLICATION TO BE ACCEPTED
Permit Number:
RECEIVED
SEP 2 9 2021
SL Lucie County
Permitting
Commercial Residential k .
Address: 7/ 4
Property Tax ID #:t3/Z- g0/ .( Qp,0 57 Lot No.
Site Plan Name:
Project Name: _ OCn%x T ,& a Zr- 9 c o _ Block No.
New Electrical Meter Second Electrical Meter
(Affidavit required)
Additional work to be performed under this permit- check all that apply:
_Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 45M .00
_ Gas Piping
_ Sprinklers
_ shutters _ Windows/Doors Pond
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Address: 7/1; , Mg : v C �.
City: _ t A �e State: Z:?-'.
Zip Code: s-3L/9t/7 - Fax:
Phone No. aal- `I -
E-Mail:,�,(� i c-��„ar . e&A L.
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
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 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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws -or an9covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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
withkend,Rr gg an attorney before commencing work or recording vour Notice of Commencement.
of
as Agent for Owner
COUNTY OFORIDA \�\
Swoyn t+� (or of r d) and subscribed beforg me of Physical Presence or Online Notarization
thisQTdayof 2C��L% by
Name of person making statement.
Personally Known OR Prodyred Ide Tcation
Type of Identification Produced ri' U L,
i k1% n e
(Signature of Notary7ublic- State of Florida )
Commission No. �;
KARE S. NIELSEN
_° , =State rl Florida Notary Public
'= Commission # GG 207484
'r��oF��o My Commission Expires
REVIEWS I FRONT I ANGRO
COUNTER I REVIING EW I S REVIEV�I�SOR I PLANSREVIEW I VREVIEW EGETATION I SE EVUERWTLE I MREV EWVE
RECEIVED
DATE
COMPLETED