HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number: / V /
91r.
C) RECEIVED
f Building Permit Application
JAWO S 2010
Planning and Development Services
Residential Permitting Department
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: U S- [
Address: zoo (o fit I s� a_
Property Tax ID#: 2 [cici 9—`6'2-- OIL_✓?,
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank —Gas Piping . _ Shutters
Electric — Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ d o?:2u
Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
!/Windows/Doors — Pond
Roof Pitch
Utilities::- _ Sewer _Septic Building Height:
Name l bttIL, v "' `' " '"'
Address: �$
City: �� State:
Zip Code:
1 fv Fax
Phone No.
E-Mail:
Fill in fee simple T�i�o next page different
from the Owner listed above)i® -�
Company:
Address:
City:
Zip Code:
Phorie;No.
E-Mail
Li
Fax:
State:
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. ,jujsl'nl+%
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SUP ME LCO -R+U LI; "
IN
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 perrrfit, 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, IA , ;,, — n++„rndnw knfnro rnmmanrina vninrk nr rprnrding your Notice of Commencement.
Signature of Own r/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5�-- w - t
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
�hysical Presence or Online Notarization
Physical Presence or Online Notarization
this c' day of 3ptc� 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 Identification
eype of Identification
Produced la G�
�
roduced
CAP-1-AA A
fix
(Signature of Notary Public- Stat f Florida)
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(Signature of Notary Public- State of Florida )
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Commission No. (Seal) ! `�<3 0 rn CD rn
ommission No. (Seal)
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DATE
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RECEIVED
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DATE
COMPLETED
Rev. 5/ b/ZU