HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPI' D FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
LLtC �.
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Prope y T6ax-FD°##
Site Plan Name:
Project Name:
w Electrical Meter
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Second Electrical Meter
Residential
fit- V i .e ce-
(Affidavit required)
Lot No.
Block No.
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: Sq. Ft. of First Floor:
Cost of Constr c"F8n 3!5_-o0 1 Utilities: _Sewer _Septic
Building Height:
011UNER/LESSEE s
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CONTtACTOR
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Address: ",C��+7zr' ' ,r c : !,
Company:
City:'.< State:
Address:
City: State:
Zip Code: Fax.
Phone No.
Zip Code: Fax:
Phone No
E-Mail: r' r-, e�
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 KtcUKutu Notice or LommencernenL 15 requuau.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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SUPRI.ENfENTAL�Q�STRiJC"CI��1�l,t�N�tA'W
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
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 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 fqr any.re'strictions 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 lendOr or a me before commencingwork or recordingour Notice of Commencement.
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Signat re of er/ L Contractor as Agent for Owner
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STATE OF FLORID
FLORIDA
COUNTY OF .
Sworn to (or a