HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: f 2 - 3.2 Permit Number: > > a •0 & Y
RECENED
91 OW
uNnOO 313M is DEC 23 2021
, Building Permit %&ton Permitting Department
Planning and Development Services St. Lucie 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:
Address:
Property Tax ID ft:
Site Plan Name:
Project Name:
New Electrical Meter Second Electrica
� YAW
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
(Affidavit required)
_Windows Doors
Lot No.
Block No.
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: ! � Sq. Ft. of First Floor:
Cost of Construction:$ 2e ;1;10 Utilities: _Sewer _Septic Building Height:
145RA-1
Pond
Pitch
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NameVrrybO
Name.
Address: V t
Company:
City: State: f�
Zip Code: Fax:
Phone No. E-
Address: u 0
City: State:'1�_t
Zip Code: 2?--9'r-'0 Fax:
hone No 5 -
Mail:y
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail oz
04A 1GW
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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
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 grantin a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Associagtion 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 an posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender drla9 fttornev before commencine work or recording vour Nntire nf CnmmanrPmpnt-
1
Signature o Co - or - O erB 'Ider as applicable
STATE OF FLOBIDA�
�1
COUNTY OF f�1nM ,
Sworn t (or affirmed) and subscribed before me of Physical Presence or _Online Notarization
this' ay of r 202:1 by 73-b hn ;Cth)n
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification r uced�� 14 -Q
(Signature of No ublic-State of —
PATRICIA ANN CHACON
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MYCOMMISSION#GG361474
Commission No. (Seal) •'o• EXPIRES: August1,2023
•., o-c„ Bonded Thru Notary Puulio Underwriters
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ev l0 12 21