HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: w - 97 • � Permit Number: 20 r(VTI &5/
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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: j-0 ffv
Address:
Property Tax ID #:
Site Plan Name:
Project Name:_
New Electrical Meter
jr /6 a -J- iL & ✓�
660 3
Second
I Meter
Residential
Lot No.
Block No.
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: $ �� Utilities: —Sewer _Septic
Building Height:
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DOWNER/,LESSEE, xr�h5r }tb �:.CONTR
Name
Name:
Address: v �0t. G c Crr.
Compan
Addres
City: o- G#li t-f State.
Zip Code: Fax:
City:
State:
Phone No. �I / � `%
Zip ode: Fax:
E-Mail: J tv LIS-(�/l m Co
P one No
E-Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is regwrea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESI`GyNER/ENGINEER ,: Not Appiic le;.
Na ei
Adess ,� =` is{` "_.`:�•��>.. r'
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a
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: " I-' :.: ii State: """
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Zip: Flioone
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 publicrecords of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
utith Icnrlor nr nn nttrimov hpfnrp rnmmpnrina work or recording vour Notice of Commencement.
ignature f Ow r/ Lessee/Contractor 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
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this day of 2020 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 Identification
Type of Identification
Produced
Produced �``,
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/b/2U