HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C ;:4 \ Permit Number:
I✓ 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: fC R'w mot coo -M v
PROPOSED IMPROVEMENT LOCATION.:
Address: Q ) \ . \ �
Property Tax ID #: 1 2-- 1 �)"
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:.
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 Constructio//nn'�- �] Sq. Ft. of First Floor:
Cost of Construction: $ L-�1 Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Address:
Name:
Company:
City: X�v J Stater
Zip Coder ._ Fax:
Phone No.
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECUKOW Notice or Lommencemem 15 regurreu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: V Not Applicable
Name: Name:
Address: Vn Address:
City: State: U City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: V Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY, AGlVot Applicable
Name:
Address:
City:
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 Co
Qnty aid posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with leAder car n attorne+v before commencing work or recording; your Notice of Commencement.
Signature o / s e nt-actor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLOR
STATE OF FLORIDA
COUNTY OF 61 M "Bea
tk
COUNTY OF
Sworn to for affirmed) and subscribed
before me of
Sworn to (or affirmed) and subscribed before me of
X Physical Presence or
Online Notarization
Physical Presence or Online Notarization
this � day of _�Pr`0 r�Ltv
2021 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 Identi ' tion
Type of Identification
Produ ed
Produced
Xd�
,V
{Sign Lure of Notary Public- StatedLWC' JULLNAN
(Signature of Notary Public- State of Florida )
�
M
NOTARY PUBLIC
Commission No.° TATE 4q2t[bR1DA
Commission No. (Seal)
? Comm# GG254435
EtxPlueti
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20