HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ____________________ Permit Number: _____________________
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ________ Residential ________
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: __________________________________________________________________________________________
Property Tax ID #: _________________________________________________________________ Lot No.__________
Site Plan Name: __________________________________________________________________ Block No. _______
Project Name: ______________________________________________________________________________________
DETAILED DESCRIPTION OF WORK:
_________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit – check all that apply:
__Mechanical __ Gas Tank __ Gas Piping __ Shutters ___ Windows/Doors
__ Electric __ Plumbing __ Sprinklers __ Generator ___ Roof __________ Pitch
Total Sq. Ft of Construction: ___________________ Sq. Ft. of First Floor: _________________________
Cost of Construction: $ _____________________ Utilities: __ Sewer __ Septic Building Height: __________
OWNER/LESSEE: CONTRACTOR:
Name__________________________________________
Address:________________________________________
City: _________________________________ State: ___
Zip Code: ______________ Fax:____________________
Phone No.______________________________________
E-Mail:________________________________________
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 HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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 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 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
A
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Co_'Pftracto_r/Licens1§o Holder
STATE OF FLORIDA
COUNTY OF
The forpo)ng instrument was acknowledged before me
thisA, `day of 19,04' i 20 ;C by
_ �K ri Me -el
Name of person making statemen .
Personally Known _
Type of Identification
Produced
STATE OF FLORIDA
COUNTY OF s r �cF
The forgoing instru ent was acknowledged before me
this /L day of /�Perc ,, 201 by
4x/ Ale
Name of person making statement.
OR Produced Identification z 'SPersonally Known _
Type of Identification
Produced
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Commission No. rF 9 F 2 L 3-4
REVIEWS FRONT I ZONING
COUNTER REVIEW
RECEIVED
COMPLETED
OR Produced Identification A 'lc
Notary Public - S at'P�f�� f Notary Public- Statc Notary Public -Stott
Commission FF 962632 y' ? » •- Commission �► FF
My Comm, Expire miWO No. �/ -f ;'' *� = �alyy Comm. Expires Ai
Bonded through Nati not Notary Assn. Bonded through National
SUPERVISOR PLANS I VEGETATION I SEA TURTLE MANGROVE
REVIEW I REVIEW REVIEW REVIEW I REVIEW