HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
a
Property Tax ID #: 14 Lj F'_ " 1 / °000
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric '1Numbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
:�1
Cost of Construction: $—l-�.a( f�, QL)
Sq. Ft. of First Floor:
Permit Number:
Building Permit Application
Residential
Lot No.
Block No.
Windows/Doors _ Pond
_ Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER hESSEE:
CONTRACTOR:
A
Name
Name• ` () I
Address: e ��
Company: I
City: a �"� State: _
Address: d
Zip Code_ Fax:
City:
State:
`� 1
Phone No.a&/: �,t� 41'
Zip Code: %
�Fax:
E-Mail:
Phone No
W5/h
E-Mail gJkplam
R®.90
Fill in fee simple Title Holder on next page ( if different
State or County License
F& O
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 recording our Notice of Commencement.
Signature wner/ Less Contractor as Agent for Owner
Signature Contractor/Li se Hol rer
!
STATE OF FLORI
STATE OF FLORIAA `'
COUNTY OF �� ,
COUNTY OF F�
w n to ( nd subscribed before me of
Swor and subscribed before me of
P Ical Presen or Online Notarization
P_ - e ce or Online Notarization
this day o 202by
thisLday of 20 by
Name of p_son making state ent.
Name of per aking state ent.
Personally Known i OR Produced Identification
Personally Kno , OR Produced Identification
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I ication
Produ e
Produce
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(Signatur c .;�i�(�y P i 9tf&6ida)
Signature of r
CO MISSION # GG 090638
LISER
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Commissi € PIRES:May 4,20$beal)
Commission P. i'= OON # G
"' ;p'���� °•'• Bonded Thru Notary Public Underwriters
ES: May 4, 2021
.......„ Qonde Bonded Thru Notary Public Underwriters
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