HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAII APPTICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDDate:Permit Number:Building Permit ApplicationPlqnning ond Development ServicesBuilding ond code Regulotion Diviion COmmefCial2300 Virginio Avenue, Fort Pierce FL 34982Phonet (772) 462-1553 Fax 1772], 462-L57a\,Residential X--+Property Tax lD #;Site Plan Name:Project Name:New Electrical MeterSecond Electrical Meter(Affidavit required)CONSTRUCTION INFORMATION:Additional work to be performed underthis permit - check all that apply:_Mechanical _ Gas Tank _ Gas Piping_ ShuttersGenerator_ Windows/DoorsR0of_ PondPitch_ Electric_ Plumbing_ SprinklersTotal Sq. Ft of Construction:Sq. Ft. of First Floor:Cost of Construction: SUtilities: _Sewer _ Septic Building Height:lf value of construction is 2500 or more, a RECORDED Notice of Commencement is required.Ifvalue of HAVC is S7,500 or more, a RECORDED Notice of Commencement is required.PERMIT APPLICATION FOR:PROPOSED IM PROVEMENT LOCATION:TOWNER/LESSEE:CONTRACTOR:Address:City:State:?Lzip Code:Q)-- Fax:Phone trto. -1( i ";r r-' ';' \ \.E-Mail:Fill in fee simple Title Holder on next page ( if differentfrom the Owner listed above)Address:Si.-'At-city:zip Code: 3\98 IFax, L\u \ 3 L,3aPhone NoE-MailN] eState or Co!nty Licensec6c 1a5,1'1 313\uu\ - [{03 ot"roq - Doo-2Lot tilo. 3Block No.DETAILED DESCRIPTION OF WORK:
SU PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION :INEER:Not ApplicableName:Address:MORTGAGE COMPANYName:)4 Not APPlicableAddress:State:PhoneFEE SIMPLE TITLE HOIDER: Y Not ApplicableName:Address:City:Zip:Ph on e:BONDING COMPANY: _Not ApplicableName:Address:City:_Zip:_ Phone:OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.I certifythat no work or installation has commenced prior to the issuance of a permit.St. Lucie Countv makes no reoresentation that is Erantins a Dermit will authorize the oermit holder to build the subied strudurewhlch is in conflict with anv aoolicable Home Owiers AsSociation rules. bvlaws or and covenants that mav restrict 6r orohibit suchstructure. Please consult witti iour Home owners Association and review your deed for any restridions dhich may apply.ln consideration ofthe granting ofthis requested permit I do hereby agree that I will, in all respects, perform the workin accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.The following building permit applications are exemptfrom undergoing a full concurrency review: room additions,accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential useWARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice forimprovements to yq/r property. A Notice of Commencement must be recorded in the public records of St.Lucie County andy'olted on the jobsite before the first inspection. lf you intend to obtain financing, consultwith lender-or afiltornev before commencing work or recording vour Notice of commencement.STATEOFFTORIDA.coUNTYoF ) Crlt/}+- Lv., <Tvpe(Signature ofcommission tloCGand subscribed before me of _ Physical Presence or -\r, r rlr lsl , zoJ L by ilcivrc\ lyrrr \ \ e IoR Prodrr.ed ldentifiretron HName of person making statement.Florida )(5eal)City:Zip: _KnownAlICNELLE GREENllotary Pub ic - stete of FloridaCommission t GG 286118Aly Comm. Exoires D€c 20,2022Eonded throlgh Natiora Notary Assn.