HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (L __ 9 lo'
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) 4624553 Fax: (772) 4624578
Address: t o IJY_
Property Tax ID #: >A �A E 4 U w �� Lot No.
Site Plan Name: Block No.
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 _Windows/Doors _Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
City: �`��--
Zip Code: 3 :!A 0\ 2 Fax:
Phone No. � 1A\ SIA--v - 7 ?,(J
E-Mail: vh_'t'
Fill in fee simple Title Holder on next nape'( if different
from the Owner listed above)
Company:
Address:
City:
Zip Code:.
Phone No
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.
Fax:
State:
DESIGNMR/ENGINEER:
Name:
Addre,
City: r
Zip:
FEE SIP
Name:
Addrec
City:
Zip:,
Phone_
OLDIE
Phone:
Not Applicable
of Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Phone:_
Name:_
Address:
City:_
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 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 your Notice of Commencement.
of
STATE OF FLORI A
COUNTY OF �-j-,�'�hC��Q
ctor as Aeent for Owner
Swo}�n to (or affirmed) and subscribed before me of
✓✓ P �rsical Presence or Online Notarization
this day of C)C,�-p 2020 by
V i C{t)' (`�-�l� NIAA - zn) C V,16 l�itl 4)4/l.
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced L
(Si at re of Notary Public- St
�YP&a`o LYSA JANE CAREW
Commission No. G.GA L �(t4'EMMMISSION4GG9ai663
a, off° EXPIRES: Decen0v 19, 2023
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No.
(Seal)
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