HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE.COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application pe Sr•'u"e
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Site Plan Name:
Project Name:
ectrical Meter U Second Electrical Meter,
Lot No.
Block No.
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:
$7S
Cost of Constructi n`�.,;f1��6
Sq. Ft. of First Floor:
Utilities: _Sewer Septic Building Height:
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ode:VF62 Fax:
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ifee simple Title Holder on next page ( if different
the Owner listed above)
Pond
Pitch
Name:
Company:
Address:
City: State:
Zip Code: Fax:
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.
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DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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
..i+k L.., 14 +tWrirle nr rarnrrlinu vnur Nntire of Commencement.
nat rye of_Q '` r Lessee/ r' 'trac�o7
as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Ph ical Prese a or Online Notarization
this day of 2020 by
Physical Presence or Online Notarization
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 Identification
Type of Identification
Produced
2N,
Produced
(Signature of Notary Public- Sfi96
of Florida)
(Signature of Notary Public- State of Florida )
Commission No.
oozaern�.,
Commission No. (Seal)
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DATE
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DATE
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