HomeMy WebLinkAboutBuilding permit appAll APPLICABLE IN O M T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
tN
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
Address:
Site Plan Name:
Project Name: _
DETAILED DESCRIPTION OF WORK:
r-
New Electrical Meter
Second Electrical Meter
Lot No.
Block No.
CONSTRUCTION INFORMATION: _
Additional work to be performed under this permit- check all that apply:
Mechanical Gas Tank —Gas Gas Piping _ Shutters
_ Electric — Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
Generator
Sq. Ft. of First Floor:
:windows ors Pond
oafJ i Z- Pitch
Utilities: —Sewer _Septic
Name r
Address:
City; Sta eV -
Zip Code Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name' Vxcj
Company:
�-
Address:
City: G�C� State:
Zip Code LQ Fax:
Phone No `I �)— 12)
E-Mail cry -
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.
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 ana mstaiiation as inuiLdLtU.
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
n �f+. rnnw hnfnru rnmmeinrinn,unrk or rPrnrriing your Notice of Commencement.
YY1L111L114,A L.l VI M��.v..a,. w�.v•r.+.+................ ____..
__ ____ _..
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Sign ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORQA
STATE OF FLOR
COUNTY OF 1C`�l ��
COUNTY OF
�kyoto (or affirmed) and subscribed before me of
Sworn or affirmed) and subscribed before me of
1_P,sical Pre or Online Notarization
P dal Pre ce or Online Notarization
this day of 2020 by
this /� day of 2020 by
/ /
4 Vick iA
Name of son making statement.
Name of person making st ment.
Personally Known roduced identification
Personally Known OR Produced Identification
Type of Identification
Type of identification
Prockiced
}
Produced
nature of Notary Public- State of Florida
�
(Signature of Notary Public- State of Florida )
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a
Commission No (Seal) °.,
l� c(Seal) °� ��
Commission No. ) ;
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REVIEWS
FRONT
COUNTER
ZONING
REVIEW
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EpIjRf�
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
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DATE
RECEIVED
V
DATE
;'
COMPLETED
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