HomeMy WebLinkAboutBUILDING PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
i_ Date: l r �cq /a Permit Number:
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:
Address:
Residential
Property Tax ID #: C 1 - gam` Lot No,
Site Plan Name: Block No.
Project Name: Cob icf
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
.Mechanical
E ectric
_Gas Tank
_Plumbing
Total Sq. Ft of Construction:
_Gas Piping
_Sprinklers
Cost of Construction:
_Shutters
(Affidavit required)
_Windows/Doors _Pond
_Generator _Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Name PP;
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Name:
Address:
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Company: CT YM7 1eAe_
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City: D
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State:
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Zip Code:
2>°-I Ci `4 Fax:
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City: Sebr\c,pr)
State: L
Phone No.Ta
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Zip Code: 3-2
Fax: 'I'l
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E-Mail:
Phone No`6�
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Fill in fee
simple Title Holder an next
page ( if different
E-Mail fx)r)OT C . Pik G 0 &cLr tp{Ck
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Owner listed above)
State or County License FC
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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.
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.
certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countyy 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
I
improve.ments to your property. A Notice of Commencement must be recorded in the public records of St.
Lu 'e ountiy and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
rt lender or an attornev before commencine work or recordine vour Notice of Commencement.
6
as Agent for Owner
STATE OF FLORIDA
COUNTYOF�}C'tiCl.l'� ice' t`'t �"�
Sworn t ,(or affirme ) andsubscribed before me of �-- hP ysical Presence or
this'- of f -1 � \ 201 by
Name of person
Wally Known OR Produced Identification
of Identification Produced
Notary Public- State
Commission No.
REVIEWS FRONT ZONING
COUNTER REVIEW
RECEIVED
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Y. SenCre M. lAelloe
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Online Notarization
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