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LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I Q Ui
All APPLICABLE _
Date: % -� �2� Permit Numbe
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Building Permit Application N41
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:
Address:
Property Tax ID_#:
Site Plan Name:
Project Name:
New Electrical Mete
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 _Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Pitch
Total Sq. Ft of Construction: Sq.: Ft. of First Floor:
Cost of Construction: $ • 9 00. Utilities: _Sewer _Septic Building Height:
Name
Address
City: . [7
Zip Code: f3 q 1�- Fax:
Phone No. !' l--y
E-Mail: � yet✓
Fill in fee simple Title Holder on next page
from the Owner listed above)
Name:
,Cor parl,
State Ad,d"r�ss
�
Cjty. State:
s;!
Zi 'Code Fax:
r, .CwA Phone No .
different. 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.
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 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 failureto. Record a Notice of Commencement may result, in payingtwice 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
with lender or an attornev'before cornmencinE work or recordine your Notice of Commencement.
Signat a of Owner essee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFT k
COUNTY OF
Sw tor affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Preset a or Online Notarization
Physical Presence or. Online Notarization
this R day of i ' 2020 by
this day of 12020 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 )
v
Commission No.
IG BISSET
om i � ion No. (Seal)
- Commission # GG 090721
REVIEWS
FRONT
BNI
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r
VEGETATION
SEA TURTLE
MANGROVE
REVIEW
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 5/bj26