HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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 CBDG Funding
PERMIT APPLICATION FOR:
Address:
Property Tax ID #: —
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
(Affidavit required)
Lot No._s_
Block No.
Additional work to be performed under this permit— check all that apply:
_Mechanical — Gas Tank Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric — Plumbing — Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ T (r z C' ]
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Name l C'. C,:5 r :y-"
Address: > --IDr
City: . State:
Zip Code: Fax:
Phone No. —"` =3 j„ E-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Q I \,q i I
Company:
Address:
C
City: tiG State:
Zip Code: (% Fax:
Phone No
E-Mail er C G )V'�
c� G
State or County License 5 1
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:
_ lc t 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: __ u
City.
City:
Zip: Phone: 1 Zip: Phone:
W C 1 RACYOR 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 rantin a hermit drill authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners ssocia Ion rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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.
'rhe 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 Mice 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 attornev before ci3rr mencinLy work or rpritirding vneer Nntirn of (nmmanr°cxmnni-
Signature of'Ovrner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworto (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this riG day of g 1 20 by
Name of person making s atement.
Personally Known OR Produced identification
Type of Identification Produced
(Signature of Notary Public- S ` e of Floridan
DANIELLE P. ZIMMERMANCommission I~1tT, (deal} .State of Florida Noiary PublicCommission
L,\
# GG 141634
My Commission Expires
September 09, 2021
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