HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Gate: Permit Number:
� t Lu� L
' Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
IFA
PROPOSED IMPROVEMENT LOCATION: i
Address: 'Cr C
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
vC Y ir), + I-i�
+
New Electrical Meter Second Electrical Meter
I CONSTRUCTION INFORMATION: I
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: Sq. Ft. of First Floor:
Cost of Construction: $ 00�no' m Utilities: —Sewer _Septic
Building Height:.
OWNERAESSEE:
CONTRACTOR:
Name
Name:
Address: �Q C �
Company: C 1
City: State:–P.
Zip Code: cal` Fax:
Phone No.
Address:
City: P-1(— _ State:
Zip Code:.- a 1 Fax:
Phone N li,Fill hwral I Ch
E -Mail;
in fee simpleTitle Holder on next page (ifE-Mail
�ff
from the Owner listed above)
State or County License
it VaIUC u1 LUIMLIUL:LIU11 n] tauu Ur more, a KtLUKUtU Notice Of Commencement Is required.
If value of HAVC 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:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SAMPLE TITLE HOLDER: — Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name: —
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
UWNLK/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
l 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 commencin work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contract s Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
,
COUNTY OF � • Li,° COUNTY OF �4 .
Sn to (or affirmed) and subscribed before me of Swo n to (or affirmed) and subscribed before me of
7Physical Presence or Online Notarization Physical Presence or Online Notarization
this _&:'flay of 'Sctn 2020 by this jj qday of S��n,E 2020 by
Name of person making . statementName of person making statement.
Personally Known v/ OR Produced Identification Personally Known V/OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public- State of Florida) {Signature of Notary Public- State of Florida )
Commission No � {{ Commission No. n �H G
Pff,��i .I -3Y G �J�JR.
y _ A? Notary Put , IR,.
ar r Notary Public -State of fl4rita of F!
_ C Stag orida
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REVIEWS �'R NY'f ZO�hI iC�S. 2 , PE'R CSR PLANS VEG "3 9A. nh "PSFR E
REVIEW REVIEW
DATE
RECEIVED
DATE _
COMPLETED
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