HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST. BE COMPLETED, FOR APPLICATION TO BE ACCEPTED \ t
Date: Permit Number: d�0 � / {� o
Building Permit Application
Planning and Development Services
Suilding.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: &NJ
Property Tax ID #: Lot No.
Site Plan Name: Block No.
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 _ PlumbingG _Sprinklers _ Generator _ Roof :-Pitch
Total Sq. Ft of Construction: I Sq. Ft. of First Floor:
Cost of Construction: $ 30� Utilities: _Sewer _Septic Building Height:
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Name) Name:
Address: -7 4� � Company:
City: Pelf State: Address:
Zip Code: 1 Fax: City: State:
Phone No. % /-7P,—\ Zip;.Code: Fax:
E-Mail: JII v✓! -? Cd Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) 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.
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DESIGNER/ENGINEER: , Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: Stater City: Stater
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 jobsitebefore the first inspection. if you intend to obtain financing, consult
with le er or an attorney before commencing work or recording our Notice of-C6m6iencement.
Si re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder .
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or a med) 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 2y
this day of , 20_ by
Name of person making statement.
Name of person making statement:
Personally Known OR Produced'ldentification
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 )
Commission No. (Seal)
Commission No. ,(Seal)
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REVIEWS
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!Pry Public
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PLANS'
VEGETATION
SEA TURTLE
MANGROVE
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021E
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.