HomeMy WebLinkAboutPermit ApplicationAll APPLICAALE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: r ;} Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential `,•' J
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED If
Address:
Property Tax ID #:
Site Plan Name: _
Project Name:)
RQVEMENT
fiATION:
v
Lot No.
Block No.Pr
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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 T
Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
�^
Cost of Construction: $-J . a0 Utilities:
—Sewer —Septic
Building Height:
OWNCR�(ESSI-E.
CONTRACTOR:
Name v2
Name: ►—
Addre s: d
Company:
l
City: State:
Address:
Zip Code: 4 9 3 Fax:
City:
Stater
Phone No.
E- Zip Code: qFax:
Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
I
from the Owner listed above)
State or County Llcense
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.
SUPPLEMENTAL CONSTRUCTl(;4 LIEN LAW INFORMATION -
DESIGN ER/EN GIN EER: � Not Applicable
Name; _
Address:
City:
Zip;
State:
MORTGAGE COMPANY:
Name:
Address:
City:
ZIP: Phone:
Not Applicable BONDING COMPANY:
Name:
Address:
City:
one. 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 confl[cts with an ap icable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult wit your Homeowners Association and review your deed for any restrictlons 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 t e jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an att ore commencing work or record iri;_yqur Notice of Commencement.
Signature of Owner/ Lessee/Contractor as wrier
STATE OF FLO
COUNTY OF
Sworn affir d) arid $bsc [bed befrr9 me of i�Physical Presence or Online Notarization
this day of 20. � by
of Applicable
Slate:
Phone_
F� EE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip -
Not Applicable
Name of person making st�t;
ftffi
own OR Produced Identification
Identification P d c
Signa a of Notary Public- State of Florida)
` : Wynn Allen
Commission No. (Seal) Comm• # G3B65$2
ftMCli.l Dru rM I
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
DATE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
DATE
COMPLETED
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372D721--