HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r ,
Date: l z 3l '� o Permit Number: V
0`4° W909
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° W° Building Permit Application
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: t
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Address:
Property Tax ID fl:
Site Plan Name: _
Project Name: _
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New Electrical Meter Second Electrical Meter
Residential
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RECEIVED
DEC 3 1 Zolo
Permitting Department
` ,St"Cucle County
=L, 31( 441
Lot No.gr—1 O
Block No. T
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: Sq. Ft. of First Floor:
Cost of Construction: $ '�?f Utilities: _Sewer _Septic Building Height:
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Name a -ii-L S
Name:
Address: !D► 149 A%Le—
Company:
City: Fj State: `
Zip Code: Fax:
Phone No. ?a Cf�`j i - S4 fg
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail:
Fill 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.
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
is in Home Owners Association rules, bylaws or, and covenants that may restrict or prohibit such
which conflict with an applicable
structure. Please consult s�ith 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 d on the jobsite before the first inspection. If you intend to obtain financing, consult
with lend o e before commencing work or rscordin our Notice of Commencement.
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MORTGAGE COMPANY:
Name:
Not Applicable
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _Not
Name:
Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Sign ner/ Lessee/Contractor as Agent Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn r affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
"Physical Presence or Notarization
Physical Presence or _Online Notarization
_Online
this � day of � G 12020 by
this _day of , 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of IdentificatiQL
Type of Identifica