HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED 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 Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 1 07) A 0
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 _ Windows/Doors
Electric Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ JJ OI jOP Utilities: —Sewer —Septic
Lot No.
Block No.
Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name
Name.
�+
Addr ss: 1
Company: j
City: FT 4)tee6eStateiegi
Address:
Zip Code: '` ,F/ax:
Phone No.477,2 ' /Crrg h—Uo
H
City:
Zip Code: %
,State a
Fax: %
E-Mail:
Phone No
'15%
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: 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 commencing work or recording our Notice of Commencement.
Sign a ure caner Lessee/ ntractor as Agent for Owner
Signature Contractor/ Icense Holder
STATE OF FLORIDA !
S
STATE OF FLOr__14VJ?J
COUNTY OF �-, ` �
COUNTY OF.x—
Sworn to irmed) a d subscribed before me of
Sworn to d) and subscribed before me of
sical Prese c r Online Notarization
ical P e r Online Notarization
this L1_ day o 1vr / 2020 by
this i d.Qy of L 2020 by
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on making statement.
Name of n lAfiaking statement. 1
Personally Know OR Produced Identification
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