HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / Permit Number:
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Building Permit Application
Planning and Development services
Building and Code Regulation Division Commercial
2300 Virginia A venue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID
Site Plan Name:
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:
_Mechanical _ Gas Tank — Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ J�
OWNERAESSEE:
Addi
City:
Lot No.-5
Block No.
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
_ Roof Pitch
Utilities: _ Sewer ,_ Septic Building Height:
CONTRACTOR:
City:-2LU� State:
Zip Code: 34"6 Fax:
Phone No- .5(D
E-Mail rL �, (,D►)r>PQn .Go»�
State or County License q
F value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
F value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
1:1;r JCompany:,
State: Ff- AddrPcc•I,l
Zip Code: Fax:
Phone No. ^6 rbo 'a{pa 071 f (0
E-Mail: r) Q QQ . wry)
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
SUPPLEMENTAL CONSTRUCTION LIEN LAW IN
B
EER: — Not Applicable
Name:
Address:
City:
Zip: Pho
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
State:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is he by 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 commencing work or recording our Notice of Commencement.
FI _
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of n ctor/License Holder
STATE OF FLORIna
��f� STATE OF FLORID�gr� em &.4
COUNTY OF 1'Yl (' a (,I� ICOUNTYOF 9 �C + V
-%Wrn to (or affirmed) and subscribed before me of
^ Physical Presence or Online Notarization
this � day of 2020 by
Ch &h tphar einvm
Name of person making statement
Sw rn to (or affirmed) and subscribed before me of
Physical Pre nce r Online Notarization
this / day of 2020 by
Danno chlberan
Name of person making statement
Personally Known OR Produc Identification Personally Known OR Pro ed Identification
Type of Identifi io Type of Identificat' n
P du ed P d ed
a)
-(Signature of NotaQtP,vhli[,Sta;e,ot+Floxida] _ _ _ _ ..
Commission No.
oV�' ON
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Notary Public State of Florida
Charrnin D
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Commissio `�
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Notary Public State of FI nda
Seal)
My Commission GG 225827
Expires 06106!2022
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Walker
My Commission GG 225827
Expires 06106!2022
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