HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �l�b2•oaD�
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Building Permit Application
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:
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Address: 0 C/► i�
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Property Tax ID#: 4�5® J(`� "�® Lot No.
Site Plan Name: ,,� vtiY(? N0. G��✓
Project Name:
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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 _Windows/Doors _Pond
_Electric _Plumbing Sprinkleees-- _Generator _Roof Pitch
Total Sq. Ft of Construction:0 r Sq. Ft. of First Floor:
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Cost of Construction: $ /Z( Utilities: —Sewer _Septic Building Height:
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Name Name: &k-'
Addre ,t Company: (,l`
City:Li State E'I- Addres (�
Zip Code: Fax City: M4 State �
Phone No. — pU3 Zip Code:��c U _ Fax:/l
E-Mail: Phone NJ19.1
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or C my 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: of Applicable MORTGAGE COMPANY: _ Not Applicable
j 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: hone: 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
with lender or an attorney before commencing work or recordin our Notice of Commencement.
;nature of Owner/L see/ - ntractor as Agent for Owner Si ature of Contractor/Li se der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OFkL..r,�.s
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
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Name of person making statement. v4 Name of person making statemen
Personally Known OR Produced Identifications Personally Known OR Produced Identificatio�t
Type of identification� Type of Identification
Pro ced Pro uced FL.
(Signature of Notary Pu.bti e _ igna ure of Notary Public-S to of Florida)
I_R.SHAHNAINGIMM-RAHMING
Commission No. f '.*: i�i:'CCtYi " ' N; GG275060 Commission No. (Seal)
�. •., T_ EXPIRES:December20,2022
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COUNTER REVIEW REVIEW REVIEW REVI VIT__Lhry e,Thrfifi&ff icunde inter IEW
DATE
RECEIVED
DATE
COMPLETED
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