HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COM
D FOR APPLICATION TO BE ACCEPTED
Date
Permit Number: �,y I - 6-56
RECENED
OCi � 51010
Building Permit Application inQDePartment
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
r-oper"ty Tax iD'#.
Site Plan Name:
Project Name: _
Perils
St. Wc1e C0unty
Residential
K)6—(DLot No.
Block No.
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 _Sprin s _Generator
Total:#Sq�_Ft�of Constr_uct.Lonr: D iS S q. Ft. of First Floor:
aYJ
Roof Pitch
�'4"T 75GT- Do sties: _Sewer _Septic Building Height:
o��.=of�Co'ri stru ctio i�: ;$
OWNERjLE�SSEE:
4 RACTOR:
;Name �c ��,i N qui
Name:
'Address: l
Company:
) ��ty: 1.�('C_� Stater
ip Code: Fax:
No. -7 J� 5 '7 q=q a
Address:
City: ' State:
-Zip Code: Fax:
Phone No --
,hone
E-Mail;__ .____.
ill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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.
A
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
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 commencing work or recording vour Notice of Commencement.
ture of Owner/ Lessee/Contractor as Agent for. Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE.OF FLORIDA
COUNTY OF 51- L.4Ja-e
COUNTY OF
Swo o (or.affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Phvsical Presence or Online Notarization
Physical Presence or Online Notarization
this L3 day of OC 20 ;54y
this day of 20_ by
Name of person making statement.
Name of person making statement.
��
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- Sta of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
(Seal)
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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