HomeMy WebLinkAboutBuilding permit ApplicationAll APPLICABLE INFO MUST BE COMPLc rED FOR APPLICATION TO BE ACCEPTED
Date:
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 I D ;
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION: i
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping
Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction: _
Cost of Construction: $
�1v
Lot No. W
Block No.
Shutters _ Windows/Doors _ Pond
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:_ U �'1
Address: / Company: U- ,D
city: c
ty: tate. _ Address: • %/0� 0./ 1� 64I_
Zip Code: 'Fax:- / City: 4 _ _/3 Stater
Phone Nq!�v
`` 5 s���a�� Zip Code: ,3 c'2_9 (Pb Fax: ----
E-Mail: - Phone No - 66
Fill in fee simple Title Holder on next page (if different E-Mail J CarJ d A,10offa.
from the Owner listed above) State or County Licensee /3C6 61a 2,
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:
Address:
City: State
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: -
.Phone: -
Not Applicable
MORTGAGE COMPANY:
Name:_
Address:
City:
Zi
p. . , ,„I
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Appli lie
State:
Not Applicable
OWNER/ CONnACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that n 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, byf aws 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
v,Ath.knder or an attorney before commencing work or recording Your Notice of Commencement.
Signature of
STATE OF FLORIDA f2
COUNTY OF
as Agent for Owner
SwW to (or affirmed) and subscribed before me of
L\P_tlysical Pre a or Online Notarization
this day of 2020 by
Name of person making statement.
Known OR Produced Identification
�Itificatior L—(,\
(Signature of Notary
~,�}Y Pt,B Notary Public State of Florida
Commission No. r° 1 �' Charmi �Iker
M Gom issGG 225827
i JExpires W0612022
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED `
DATE
COMPLETED
re
STATE OF FLORID/,4a�
COUNTY OF �� aa#_�
S n to (or affirmed) and subscribed before me of
Physical Pres ce or Online Notarization
this day of 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Typ f tifiication
Pr
(Signature of Not c 3f— r
°� s Notary Public State of Florida
Charmin D VV I er
Commission No. 7 My commissio-San...
ru:n xPres 06/0612022
SUPERVISOR PLANS
REVIEW REVIEW
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