HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Application Permitting Department
Planning and Development Services St. Lucie County
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:
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f?R'®POSE�D�IM ROs � MENTALaO,C T O r
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Address:
Property Tax ID #: '�Cl 60� ^001-f) —OOD Lot No.
Site Plan Name: Block No.
Project Name:
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A ditional work to be performed under this permit - check all that apply:
Mechanical q�'G as Tank 0/1%as Piping AShutters 04, Windows/Doors � /Pond
� IV lumbin � Sprinklers 'Generator l� Roof f Pitch ��' Electric �P g- P ��— �—
Ft Construction: A C7- iC J13 ';)7 Sq. Ft. of First Floor:
Total Sq. of
d Utilities:m/—A'Sewer AllA3eptic Building Height:
Cost of Construction: $ •
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Nam Name:
Address: Company:
City: pwjt State: Address:
Zip Code: Fax: %- City: State:
Phone No. i vl �'�0 Zip Code: Fax:
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E-Mail i alr Phone No
Fill in fee ple Title Wolder 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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MORTGAGE COMPANY: — Not Applicable
Name:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: Not Applicable
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
1AAfk lonrlor nr nn nttnrnov hofnrP rnmmPnrina wnrk nr recordine vour Notice of Commencement.
Signature o ner Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF. L& LZ Z -e
COUNTY OF
Sworn (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Ph sical Presence or Online Notarization
Physical Presence or Online Notarization
day 2020 by
this day of - , 20AJby
this of
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifica 'on
f Identification
Produced
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(SignattTre of Notary Public- Sta o Florida)
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