HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j
Date PernitNumber: ! � ' •..
111111 II�� �UI. -
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Building Permit Application
Planning and Development Services
Building and Code t?egulationDivision Commercial Residential'
2300 Virginia.Avenue,Fort Pierce FL 34982
Phone:(772).462-2553 Fax: (772)462-1578
PERMIT APPLICATION.FOR:
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PropertyTax ID#:__ 1V ��=� Lot No.
Site Plan Name: Block No.
Project Name:
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New electrical Meter Second Electrical Meter
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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
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Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ' L9 4 Utilities: _Sewer —Septic Building Height:
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Name i 'J 1.1 Name:
Address: k C e i'Cle Company:
City: r Pfer-ck State:`.. Address:
Zip Code:3 Fax: City: State:
Phone No. �- �'Q�r�� f, - Zip Code: Fax:
E-Mail: Phone No
Fill.in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) 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.
S P EM TCONS 1•N VV • NOTION,
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Add ress:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 l 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 applicationsar exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fenc ,walls,signs,screen rooms and accessory uses to another non-residential use
"WARNING TO OWNEYOUR FAILU TO
it: RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWIVTD
OR IMPROYEIIIIENTS TO OUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSON THE JOB SATE BEFORE THE FIRST INSPECTION:1F YOU INTEND TO OBTAIN FINANCING, CONSULT
WITU LENDER OR AN ATTORNEY BEFORE RECORDING YOUR.NOTICE OF COMMENCEMENT."
XI
Signature of Owner/Lessee/Co ra r as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA t STATE OF FLORIDA
COUNTY OF S*. COUNTY OF
The forgoing instr�u n,ent,was acknowledged before me The forgoing instrument was acknowledged before me
this ",day of J O V,'9 26 by this day of ,20_ by
Name of person making statement. Name of person making statement'.
Personally Known OR Produced Identification Personally-Known OR Produced Identification
Type of Identification Type of Identification
Produced- L Produced
(Signature of NotaryPublic-S �eGN�g (Signature of Notary Public-State of Florida)
DFA��AMR.
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Commission No� _ . - MY co �� 2020
mbar 18, Commission No. (Seal)
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REVIEWS_ FR ZONING SUPERVISOR -PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE , ,
RECEIVED
DATE
COMPLETED