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HomeMy WebLinkAboutBuilding permit appAll 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 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 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 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 with lender or an attorney before commencine work or recordine your Notice of Commencement. nev./o/Lu Signature of tont7ractor/LicerXe Hoider Sig ature of Owner/ Le-sseolConfractor as Agent for Owner STATE OF FLORIDA STATE OF FLORIDA COUNTY OF SAN01 1,01CA41 COUNTY OF 511�,tnT U.AC4•G. Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of ✓ Physical Presence or Online Notarization "I _✓Physical Presenc or Online Notarization 2"1 this I day of _ A 12020 by this day of .2020 by �a�4rt �Ci�xah `�-��j 'lh3 C•�� Name of person making s!tatement. Name of person making 1fatement. Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Prod u d Produce {Signature Vd (Signatur a ..Vo y ANGEL A Commission No q. tornm+uwnt1GG082a1} , : ANGELA . Commission N` ;. 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