HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IT Permit Number:*
x
P, X.M. 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:
Address:
P r o p e r t y T a x I D #:
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
Total Sq. Ft of Construction:
Cost of Construction: $
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: Sewer I Septic Building Height:
Name yia Name: T, - �r-N
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T Address: J Companys"
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City: State: Add r ss: U;
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7777-'� State:
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Zip Code.
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Phone No.
Zip Code: Fax:
E-Mail:
Phone NOgp
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Fill in fee simple Title Holder on next page if different E-Mail C)\.',
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from the Owner listed above) State or County License_
If value of construction is 2S00 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,SO0 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Address:
City:
Zi p: Phone
Not Applicable
State:
FEE SIMPLE TITLE MOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
C i tv:
Zip:_Phone:,
BONDING COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Not Applicable
State:
of Applicable
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 dome 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
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Sig of Owner/ Le see/Co actor as Agent for Owner
Sign a of Contractor icense older
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA .K
COUNTY OF
Swor -to (or affirmed) and subscribed bef re me of
Swore to (or affirmed) and subscribed before me of
P sical Presence or Online Notarization
Physical Presence or Online Notarization
this day of I�IAA �.�` 2020 by
this day of 2020 by
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Nark of person making statement.
Name of person making statement.
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Personally Known _ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Pro e
Produce
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(Sig atu o otar Pti' -
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Pry,,, SHANNON DEPUE
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