HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number&(( -ol`1�
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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:
Address: —/ 5_6 / I _ tWe-., a /'—/, Vt L`wC,
Property Tax ID#:Cqq OW - 131•0ml•DaU?
Site Plan Name:
Project Name:
Lot No._
Block No.
New Electrical Meter Second Electrical Meter
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Additional work to be performed . under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator'
Total Sq. Ft of Construction:
Cost of Construction: $ �7� 3 C)
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
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OWNER/LE�SSEEi
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CONTRACTOJR ,7
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Name
Name:
Address: 0 Z <'
Company:
Address:
City: State:/, G
City: State:
Zip Code:3VL) 4/7 Fax:
Phone No. 72 - r2-�op__ Glr�/'L
Zip Code: Fax:
E-Mail:
Phone No
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 RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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iSsUiPaP'L ENTAyL C �i�IS'fRU ®N4LIEN LAu g l.N
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 orprohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may
apply.
pIy.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all kespects, 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 lender or an attorney before commencing work or recording our Notice of Commencement.
Sature of Owner/ Lessee/Contractor as A er or OwnSignature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF M. hs COUNTY OF
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Physical Presen a or Online Notarization Physical Presence or Online Notarization
this day of v 2020 by this day of 2020 by
Name of person making sta Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(' na ure of Notary Publi State of Flo '
(Signature of Notary Public- State of Florida )
Commission No.
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LASM1iMiND �tp,HMiN�
Commission No. (Seal)
Commission
* `
2022
EXPIRES: Decembe o U0 aervrci�ers
REVIEWS
%19J ...••per n e
�
ONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW
COUNTER
REVIEW REVIEW
REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.