HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: nnii�'l'�' Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential d
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: k,.f,tz7 (+i kv�N
Address: -
Property Tax I D #:
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction;
Cost of Construction: $(-
_Generator
Lot No.
Block No,
_Windows/Doors _Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: _Sewer _Septic Building Height:
:OWNER/LESSEE;
CONTRACTOR:
Name e year i; of+-
Name:
Address: 7 � ( 71Ay�" `'�
i
Company:
a, City: �rj (sefec
ZipCode: ,;f Fax: "77t
Phone No. '" 7= 'r
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State:R
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: "i.%Or�N t)c..ij� &JA56WO z 0
Fill in fee simple Title Holder on next page (
from the Owner listed above)
if different
E-Mail
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.
SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: eNot Applicable
MORTGAGE COMPANY: �L Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable
BONDING COMPANY: ,4' -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 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 comme cing work or recording our Notice of Commencement.
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/
Signature o Owner/ Lessee Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF
OFLORIDA
COUNTY OF �s� �,e
COUNTSTATE
YOF
Sworryyrto (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
physical Presence or Online Notarization
Physical Presence or Online Notarization
this _ day of 2020 by
this _ day of A2020 by
Name of person making statement.
Name of person making statement.
Personally Known ZOR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Pu ' - " 4Gicla
(Signature of Notary Public- State of Florida )
w+,, DAVIDYOUNC�
Commission No, Comm!GG33977DJae
Commission No. (Seal)
o`•'Expires June 3,202$
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