HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� �I Permit Number:
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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: LEU
Property Tax ID #:
Site Plan Name:
Project Name:
01
Building Permit Application
Residential �4
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Lot No.
Block No.
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New Electrical Meter
Second Electrical Meter
(Affidavit required)
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itional work to be performed under this permit— check all that apply:
echanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $U(O.liC�
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
Name +1`CV`f fl `
Address: fQ f
City: State:
Zip Code: 3 Fax:
Phone No. n�q��
E-Mail: S ece ! ! 00l0
Fill in fee simple Title Holder on nextRoage ( if different
from the Owner listed above)
Name: v LO t
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Company:
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Address:
City:
State:
Zip Code:
Fax:
Phone No y7-0�9 -1,5 13
E-Mail ///
State or County License
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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.
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 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 pos ed on the jobsite before the first inspection. If you intend to obtain financing, consult
with 1,a0der or an a o ney before commencing work or recording our Notice of Commencement.
Signature o wner/ Lessee/ ractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swor (or affir ) an s ibed before me of —Physical Presence or Online Notarization
this day of 2l� by
,a� .t�
Name of person making statement.
Personally Known Produced Identific ion
Type of Identificati n Prod c ct
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0
(Signature of Notarry, Public -State of Florida) ..r
(.� /��{�/ J �20�YP`•':�: PATRICIAR.HILL
Commission No. 1/fA // i/��((// oV (Seal) .; *, MY COMMISSION#GG976680
EXPIRES: April 7, 2024
Bonded Thru Notary Public Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21