HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 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:
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'77qZ 0 SO D'i AP -A Lt Address:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
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10 114 D,�
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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 ----plumbing Sprinklers Generator —Roof —Pitch
Total Sq. Ft of Construction: TO 3n 7�( Sq. Ft. of First Floor:
Cost of Construction: $ L( Utilities: —Sewer _Septic Building Height:
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Name F)OU-17"
Name:
Name.
Address: '2 4ZO S�Z�, ()tecA+-�'
Company:
Company:
City:-- Z-421S,'LJ',3 (7�itAdA- State:
Address:
Address:
City: State,
Zip Code: ?49,�z, Fax:
Phone No.
Zip Code: Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License
from the Owner listed above)
If value of construction Is 2500or 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:
e—Not Applicable
Name:
Name:
Address:
City:
State:
Address:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: L '-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 tounttyy 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 attnrnpv hpfnrp nnrnmPnrinP work nr rprnrdino vnur Nntirp of rnmmPnrPmPnt_
Signatu Owner/ ssee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA,y
STATE OF FLORIDA
COUNTYOF � _L3
COUNTY OF
n to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
sical Presence or Online Notarization
Physical Presence or Online Notarization
t is�dayof 2020 by
this _ day of 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification ('�
Personally Known OR Produced Identification
Type of Identificati
Type of Identification
Prod ced y !
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Produced
(Signature of Notary Public- Stat Florida) ror.
ignature of Notary Public- State of Florida )
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