HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Crate: Permit Number:
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` • ` Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: (UU, I M. i
Property Tax ID#: J5—
Site Plan Name:
Project Name:
VNAMMIM9MeMra11111111M
New.Electrical Meter Second Electrical Meter
Lot No. -
Block No.
A dit nal 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: n Sq. Ft. of First Floor:.
Cost of Construction: $ ► ao Utilities: —Sewer —Septic
Building Height:
Name-
Name: 1
Address:
Company:WJ
Address:
City: State:
Zip Code: Fax:
Phone No.
City: So-m-I &^ State:_
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail r ftl
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.
DESIGNER/ENGINEER: � Not Applicable
Name:
MORTGAGE COMPANY:V ____Not
Name:
Applicable
Address: _
City:^T State:
Zip: Phone
Address:
City:
Zip: Phone:_
_State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY:
Name:
Not Applicable
Address:
City:
Address:
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 l 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 OWNE/Yoailure to Record a Notice of Commencement may resu in paying twice for
improvements tooperty. A Notice of Commencement must be rec ed in the public records of St.
Lucie County andon the jobsite before the first inspection. I ou " end to obtain financing, consult
with lender v before eommencin>7 work or recordi ou otce of Commencement.
Signature n Lessee/Contractor as Agent for Owner
Signat Mc o tractor/License Holder
STATE FLORIDA )30aj,2rd
STATE OF FLORID
COUNTYOF
COUNTY OF (IL J
w n to for affirmed) and subscribed before me of
P sicaI Pres ce r Online Notarization
t is day of �9 15-b
Sw n to (or affirmed) and subscribed before me of
Z Physical Pre nc or Online Notarization
this day of ?9 by
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Name of person making statement.
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Name of person making statement.
Perso y Known Produced Identification
Perso Ily Known OR Produced Identification
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Commission No.
Commission No.
REVIEWS
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SUPERVISOR
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REVIEW
REVIEW
REVIEW
REVIE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20