HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
oLP L ...
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:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric —Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
(Affidavit required)
_ Windows/Doors _ Pond
Generator /_ Roof Pitch
Sq. Ft. of First Floor: , `0.as
Utilities: —Sewer _ Septic Building Height:
OWNER LESSEE:
CONTRACTOR:
Name
Name:
Company: y,
Addres (i7 Y
Address
t +
City: Stater
Zip Code: Fax:
Phone N
City: Sta e:
s
Zip Code: F L
Phone N
E-Mail: ,f ,,
Fill in fee simple Title older on next page (if different
from the Owner listed above)
E-Mail'.a r r
State or County Licensei 2, C, 19(�
it vague or construction is csuu or more, a KtLUKL)tL) 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 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 such
prohibit
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 Count ,.land posted o e jg. ite before the first inspection. If you intend to obtain financing, consult
with lend or an attofn of commencing work or recording our Notice of Commencement.
�* Notary Public State of Florida
Francine Rafferty
Si ature of Owner/ Lessee/Contractor as Agent for Owner � Expires MY Commission H o36185
STATE OF FLORIDA
COUNTY OF Hg(Z-:
_
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this Z day of ` 201) by
Name of person making statement.
Personally Known ('"
OR Produced Identification
Type of Identification Produced
m
(Signature of Notary Public- Stat lorida
Commission No. 414 03(o lq.T (Seal) �''0'(* Notary Public State of Florida
YJFrancine Rafferty
My Commission HH 03I;1gg
-1o,ryo
Expires 12/17/2024
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