HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
- _
JAN 2 S 1011
Building Permit Application
Permitting De eat
Planning and Development Services
S . Luci unty
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:
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Address: u
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Property Tax ID #: l � �"" � �'' boor 00V` /
Lot No.
Site Plan Name:
Block No.
Project Name:
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NewElectrical Meter Second Electrical Meter
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: / 120 Sq. Ft. of First Floor:
CgfGaustrtion$ ui ��� Uti ities: —Sewer _Septic
Building Height:
fVame pt�i'J�! /11—� Name:
Address: G9'ke w U Company:. .
Cityede State: Address:
Zip Code: -:3 Y9,S V Fax: City: _
State:
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Phone No. -- 6V7.5 —O e� 5Zip Code:
Fax:
E-Mail: ,60&, ' ne No
Fill in fee simple Title Holder on next page( if different E-Mail
f m the Owner listed above) State or County License
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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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY:' _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicatea.
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
%AIii-k lonrior nr nn nttnrnav_.iafnra rrirrmmanrinPr wnrk`nr recording vour Notice of Commencement.
Sgyzure of O er/ L see/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA _
STATE OF FLORIDA
COUNTY OF /
COUNTY OF
Sw fn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Pres nce or Online Notarization
Physical Presence or Online Notarization
this day of i 20 by
this day of 20_ by
Name of person making statement.
Name of person making statement.
%
Personally Known OR Produced Identification ✓
Personally Known - OR Produced Identification
Type of Identific
Type of Identification ,
Produced L
Produced:
i
(Signature of Notary
(Signature of Notary Public- State of Florida )
"may pV�/� KAREN S. NIELSEN
-.
Commission No.
;_� ;State of $b f -Notary Public
= Comm Pb �# GG 207484
Commission No. (Seal) -
oQPc My Commission Expires
11"�1'�
°i June 12 2022
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