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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and peveiopment Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRICTION INFORMATION:
Lot No.
Block No.
Additional work to be performed under this permit- check all that apply:
Mechanical — Gas Tank Gas Piping Shutters
— _ WindowslDaors pond
— Electric — Plumbing — Sprinklers Generator
— f Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor;
Cost of Construction: $ c ;-7Q50 60
Utilities: ^Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
'Name J Name: LC c�a r3f
Addr
City: Company:
State. Addr AJ �Q P"
Zip Code:Fax: City:
Phone No ,2 State:
Zip Code: _ Fax:
E-Mail: Phone Now 2�Z(o
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.
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 TITLEHOLDER: _ Not Applicable
BONDING COMPANY: Applicable
Name:
__,Not
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 {saying 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.
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Signature of Contractor/License Holder
Owner essee ntractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY ;,.yl /.� (yam
Sw to (or affirmed) and subscribed before me of
COUNTY OF
Swo a (or affix and subscribed before
sical Pre ce or Online Notarization
this of 202i) by
me of
Ph,,- icai Pre ear or Online Notarization
this day of 2024 by
Name of person making stateme
Name of person making ss atemm
Pe onally Know OR Produced Identification
Pers nown 'r OR Produced identification
Type of Identificat on
T pe of ldent cation
Produced
Produc d
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(Signature of Nokary Publi St to of Florida }
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(Signature ofAij
Commission No. ea4otary Public state or F
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Pamela Jones
r_ My Commission GG 98
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DATE
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DATE
COMPLETED
ev. 5 20