HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION.TO BE ACCEPTED
Date: Permit Number:
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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: -7�
Property Tax ID #:
Site Plan Name:
Project Name:
New Electrical Meter
(4000 - (��r7�1 Lot No._
Block No.
Second Electrical Meter
(Affidavit required)
Add /inal work to be performed under this permit — check all that apply:hanical Gas Tank —Gas Piping _ Shutters Windows/Doors _Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
eY�
Cost of Construction: $ T��O b
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Building Height:
Name d9 ��� OSC _ Name: 14r
CJd/ r Irl
Address: i Q�-+'t F `fs ,'~Company.;
city: �y Soh eQG :f .;`1ry Sfate:.-C-;:Qddres IJ ('�'/Ip
Zip Code: V9 e7 _ C��� C� �`L- State:
Phone No. 77�Code: ��i�S Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail �!/�-c�00
from the Owner listed above) State or County License<Sf17Y%3
If value of construction is 2500 or more, a RECUKutu Nonce
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
"Not
non 115
DESIGNER/ENGINEER: 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 posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attDwey before commencing work or recording our Notice of Commencement.
ature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA 1
COUNTY OF.t�
Sworn to (or affir ed) and subscribed before me of _ Physical Presence or Online Notarization
this, aday of 20W by
Name of person making statement.
Personally Known OR P?duced Identification
Type dentification ProducedF- L-- 4�
(Si ure f Notary Public- State of Florida )
Commission No. (Seal)
+� K= p(pIRES: Decem 10.2112
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUP
REVIEW
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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