HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED OR APPLICATION TO BE ACCEPTED
Date: � oo Permit Number: a`�4-i daUs
®t�Ni nzF oJUL 1 3 2020
Building Permit Application
Planning and Development Services ST. Lucie ounty, Permittirtig
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address:
Property
Site Plan Name-
Project Name: _
Block No.
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping —Shutters _ Windows/Doors _.Pond
Electric _ Plumbinn/d�g _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 1 /Sq. Ft. of First Floor:
Cost of Construction: $ G45 a in Utilities: —Sewer _Septic
Building Height:
Name Qkf
Name:
Address:
City: '`' I i( State.F�,
Zip Code,39gS I Fax:
Phone No. lil C)
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail. (J , /�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above) 1 a ' a l �O - 3� d
E-Mail
State or County License
It value of construction is Z500 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/EN INEE� _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name• S
Name:
Addr ss:
Address:
City: State:
2ip: Phone:
City: Stat
Zip: P one 5-
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 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 attornev before commencing work or recording vour Notice of Commencement.
'Sigrfature of Owner/ Lessee/Contractor as'Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA _ �
STATE OF FLORIDA
+`
COUNTY OF �l�'6 AJ��
COUNTY OF
Swor to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
_ Physical Presence or nline 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
(6a&Koflhlotary Public- State of Florida
Public- State of Florida)
/� oi►pYP�e
Commission No. C (Se )`?. �� Notary
AMIE OCONNOR
uIffiarr takv, 0 (Seal)
Comn
isslon # GG 963729
My Com
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