HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: tJ Permit Number:
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:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID ##: "��� -- l7� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK...
New Electrical Meter Second Electrical Meter
[CONSTRUCTION INFORMATION'..
Additional work to be performed under this permit- check all that apply:
Mechan' ical _ Gas Tank —Gas Piping _ Shutters � Windows/Doors _ Pond
_VIE iectric _ 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_ IAAXI_50tjr(_t
Name: A L,J
Address: GZ
Company:-W.m r .ytc
City: a Pi2.ck _ State:
Zip Code: Fax: /V
Phone No. €€ r
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City: State: t-
Zip Code: i! Fax:
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E-Mail: r3s M �!f [jt.Q(:)Oq
Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
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State or County License? l57
It value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value pf HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
Zip: Phone:
OWNER/ C:UNTRACTOR 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 vour Notice of Commencement.
ignature ontr or icense Holder
Signature er/ Les i actor as Agent for r
ST F FLORIDA
COUNTY OF
S �LOR�IDA
COUNTY OF uc'
Swopn to (or affirmed) and subscribed before me of
Physical Presence
Swoo to (or affirmed) and subscribed before me of
or Online Notarization
this J hAday of 2020 by
Physical Prese ce or Online Notarization
thisday of 2020 by
Name of person making statement.
Name of person making statement.
�
Personally Known L.�OR Produced Identification
Personally Known OR Produced Identification
T e of ldentifcation
T p of Identification
P o aced
P o ced
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Rev. 5/To/ 25