HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
Date: Permit Number: ®/
O 6uigiuuad
p F-° Building Permit Application 'gun°ag'°nj ;S
Planning and Development Services I Z 0 Z I O d 3 S
Building and Code Regulation Division Commercial Residential
Building
Virginia Avenue, Fort Pierce FL 34982 0
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
I PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:,..
Lot No.
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: Sq. Ft. of First Floor:
Cost of Construction: Utilities:_ Sewer_ Septic Building Heigh
t:
OWNERAESSEE:
CONTRACTOR:
Name Lt
Name:
Address:
Company:
City:UState:
Address:
Zip Code: Fax:
City: State:
Phone No. I, 41 �— S: . E-
Zip Code: Fax:
Mail: 2yu muVY&M Lip -(,I) W1
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.
(�3-3 X 2-Tl col s7 �3 8 La 33
SUPPLEMENTAL"CONSTRUCTION LIENaLAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone -
Zip: Phone:
FEE SIMPLE TITLEHOLDER:' _ 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 conflicts with any. applicable Homeowners Association 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.
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 attornev before commencing work or recording vour Notice of Commencement.
Kk
Signa ure of Owner/ L see/C Vractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF �51 L,LJ r
Sworn to (or affirmed) and subscribed before me of _
Physical Presence or Online Notarization
this I day of 1� 20� by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced ;DL
(Signature of Notary Public- St a of Florida)
111Bi, HEATHER BURFORD
Commission No. _ (Seal) State of Florida -Notary Public
=
Commission # GG 183217
`Z
MY Commission Expires
February 06, 2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21