HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BECOMPLETED FOR APPLICATION TOBEACCEPTED
Date: Permit Number:
Building Permit Application
Planning ondDavOupment Servicex
Building and Code Regulation Division CorDDl8rCi31 Residential
23V0Virginia Avenue, Fort Pierce R3498
Phone: (772)462-1SS3 Fax: (77Z)4G2-IS78
PERMIT APPLICATION FOR:
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[�P:ROP(5SED IMPROVEMENT LOCATION:
Address: 105—
Site Plan Name: Block No. A-L
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
|CONSTRUCTION INFORMATION:
Additional work tobeperformed underdhispennit-checkaUthatopply:
—Mechanical __ Gas Tank Gas Piping $hutter's Windows/Doors Pond
__Electric __Plumbing Sprinklers __Generator Roof Pitch
Total Sq. PtofConstruction: Sq. Ft. of First Floor:
Cost ofConstruction: $ Utilities: __Sewer __Septic Building Height:
CC
Name
Addre 15
FrNq am e
Company:
City: ate:
Address:' Ank P1
Zip Code: Fax:—
City�
Phone No
Fill in fee simple Title Holder on next page if different
E-Mai
State or County License_a_
om the Owner listed above)
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If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: -�
DESiGIVER/ENGINEER:i Not Applicable
Name: T
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: _ State:
I Zip: Phone_
city: State:
Zia: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
! Name: T _
Address: - -
_
Address:_ _
City_
--_
Citor:
Zip:_ Phone:
Zip:
OWNER/ CONTRACTOR AFFIDVIl : 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 tesullt 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 Ag nt or Owner Signature of Contra ctoT/Licl rise Holder
Le I
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Swoyfi to (or affirmed) and subscribed before me of
cal ence or Online Notarization
this d y o 2024.by
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Name of person makin statement.
Personally Known _________ OR Produced Identification
Type of Identification
Produc d _
(Signature of Notary Public- State of Florida
ST,RTE OF FLODt, _..._
COUNTY OF
Sw;) to (or affirmed) and subscribed before me of
_ P al Pr nce or Online Notarization
this a of� � _ 20Ay
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Name of person makin stat€ merit.
Personally Known OR Produced Identification
Type of Identification -
Produced_
(Signature of N44" 12-whimr- State of Florida )
Commission No.
P ,�l i '�4 5, JR.
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Commission No.
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cr c :ry Put.,, State of Florida
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:� �- Commission At GG 966763
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March 08, 2
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