HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `c} -a Permit Number:
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c Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462.15S3 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
_PROPOSED IMPROVEMENT LOCATION:
V Address: T
Property Tax ID #: 5 '- C]1� V1 '\ Lot No.�
Site Plan Name: Block No.
Project Name: l
DETAILED DESCRIPTION OF WORK: 1
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Add' tonal work to be performed under this permit - check all that apply:
echanical Gas Tank Gas Piping Shutters Windows/Doors Pond
Electric Plumbing —Sprinklers —Generator Roof Pitch
Total Sq. Ft of Construction: q� Sq. Ft. of First Floor:
!� Cost of Construction: $ i Lam} Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: - -
CONTRACTOR:
Name k
Name:
Address:
Company:
City: State:
Address:
�n1
Zip Code: "1 Fax:
City: r Stater
II
Phone No. Mg- - LA
Zip Code: Fax.
E-Mail:
Phone No a -
E-Mail o
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County LicenseAR
IT value of construction is LSUU or more, a RECUROED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
=SUPPLEMENTAL GONSTRUGTIOi L ENEAW INORIVIAION
- - - —ter
- - ---
_ --
DESIGNERJENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zi p: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name.
Address:
BONDING COMPANY: TNot Applicable
Name:
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.
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: ur failure to Record a Notice of Commencement may esult in paying twice for
improvements toy r property. A Notice of Commencement must b ecorded in the public records of St.
Lucie County a=orneY
ted on the jobsite before the first inspection. I u intend to obtain financing, consult
with lender or before commencing work or r�ordi r Notice of Commencement.
Signature wnear/ Lessee/Contractor as Agent for Owner
STATE OF FLORID'
COUNTY OF
SW
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or , Online Notarization
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STATE OF FLO
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thi day of � �yI
Name of Person making
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Commission No.
REVIEWS
FRONT
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SUPERVISOR
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VEGETATIO(
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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