HomeMy WebLinkAboutBuilding permit appAll APPLICABL INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: P MUST BE
Permit Number:
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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:
PROPOSED IMPROVEMENT LOCATION:
Address: 01(D2
Property Tax ID #:
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Site Plan Name: Block No.
Project Name:
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PS
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
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Shutters _ Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Name Vn-r`fAN '�w��►�
Address: v ��CC 7f
City: State
Zip Code: ri S Z-- Fax:
Phone No�1Z
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company: jYLt7Qs2� 1A--J✓ ..2
Address:C2,J,�-�
City: Stater \
Zip CodeFax:
Phone Noo�Z �l"1 • ��S
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State or County License 32-q
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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�������xESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY: Not Applicable
ame:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
2< Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Ap le
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: P e:
OWNER/ C RACTOR 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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORA;
COUNTY `�'r �-� C►�
STATE OF FLORIDA
OF
COUNTY OFte-
rn to (or affirmed) and subscribed before me of
Sw rn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
hysical Presence or Online Notarization
This day of �' by
this Z day of 'by
Name of person making statement.
Name of person making statement.
Personally Kno teoMeetJt4�gtifiexl�istywn�
Personally Kno �c ti
Type of Identification .d" Notary Public State of rlowla
Type of Identification ,0' •t� Notary Public State of Flrnui:a
Produced . Ashley Del Toro
Produced ?%o Ashley Del Toro
%_ yEmnmissfon HH 052369
aw� Expires 10/1112024
• My commission HH 052369
a"� Expires 10/tt/2024
(Signature of Notary Public- State off Florida )
(Signature of Notary Public- State ojf Florida )
(
Commission No. 0�✓� I (Seal)
Commission No. 23 ICJ f (Seal)
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Rev. 5/6/20