HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO I>•iiUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEI ED
at. Lucie County
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Building Permit App���®� Permitting 6��
Planning and Development Services Residential
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:
_ '�-o (�•✓emu - vr� i "
®� Lot N0.__
Property Tax ID tt:
Block No.
Site Plan Name: :
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_ -� :-_I +-, Sarnnd Electrical Meter (Affidavit required)
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Additional work to be performed under this permit — check all that apply: s
Shutters Windows/D6brs — Pond
_Mechanical _ Gas Tank _Gas Piping _ —
Roof ` ' � r Pitch
_ Electric — Plumbing _ Sprinklers _ Generator —
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction�� Utilities: _Sewer _Septic Building Height
N me
Address:
u City: _ ��'
Zip Code: 2 Fax: c�
Phone No.
E-Mail:
Fill in fee simple Title Holder on next Page if different
from the owner listed above)
City: 1 f ee State:
Zip Code: Fax:
Phone No �' a^
E-Mail—Nla�' � 2
State or County Li ense I/1 6gL 00 cl
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of FIAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
®ESIGRIER/EN lCiIIVEER. —Not
Name:
Applicable
AGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE MOLDER: _
Name:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Q.elll NLK/ LUNTRACTOR 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 thaVI 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 .k
WARNING TO OWNER: Your failure to Record a notice of Commencement may result in paying thrice 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 .
wij_h lWder or an attorney before commencing work or recording your Notice of Commencement:
Signaturkrwner/ Lessee/Cont r* Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affir ) and subscribed before me of _
this IQ- day of 2&V by
NamYof person Riaking statement.
Personally Known OR Proc
Type of Idrytification Producel—L.
Identificatio
Physical Presence or Online Notarization .
(Signatu'rrig of Notary Public- State of Porida)
Commission No. (Seal)
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