HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -1 dU _ 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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:I `I
Address:
Property Tax ID #: L'
Site Plan Name: `-
Project Name:
DETAILED DESCRIPTION OF Wf)RIC-
_ Lot No._ z
Block No.
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 — s(iutters _ Windows/Doors
IS Electric _ Plumbing _ Sprinklers /Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor-:
Cost of Construction: $ t �t 55. [ 1 Utilities: —Sewer _ Septic
OWNERAESSEE: - - - COte
Name
� Nam
Addr ComCity: Stat--AddrZip Code• Fax• City:
Phone , o,-' Zip CE-Mail:1 1 ��( Q1 �' PhonFill in fee simple'Title Holder on n page ( if different E-Mafrom the Owner listed above) State
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.
Building Height:
Pond
Pitch
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY:
Name: _ Name:`
Address: Address:
City: _ State: City:
Zip: _ Phone Zip: 'none -
FEE SIMPLE TITLE LDER:
Name:
Address:
City:
Zip: Phone
_ Not Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: _ Phone:
_ Not Applicable
State:
TNot Applicable
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 I will, in aIf 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 attorney before commencing work or recordin_-our Notice of Commencement.
Signature of r/ Lessee/Contract ge 4
E OF FLOFL
COUNTY OF U1LQp L�fUDI -CL
Sworn to (or affirm and subscribed bore me of Physical Presence or
this � day of _ 20�1 by
t�vicel� _
Name of persIon making statement.
Personally Known OR Produced Identification
Type of Identification Produced v
Online Notarization
(Signature 10 taryPublic- StateofFlorida) ;p.p;s MARY BROWN
Commission
701
Notary Public -State of Florida
•= Commission a HH 37071
o. (Seal)
=s
?, OF`��.` My Commission Expires
August 26, 2024
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