HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE I FAO IMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f�dl Permit Number:
71
t v' a E L. 1-- Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 349g2
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: �` i
PROPOSED IMPROVEMENT LOCATION
Address:
Property Tax 1D #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WnRK-
Residential `/
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under t�his/hermit— check all that apply:
_Mechanical Gas Tank 7 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 Height:
OWNER/LESSEE: _ CONTRACTOR: - -�
Addrys-In (Lai w -- CIA
J � Company:
. Stat-. _ Addr•= s
Zip Code: Fax: City: g_Fax:
Phone No. — �,Q Zip Code: E-Mail_ Phone NoFill In fee simple itle Holder onnext page { if different E-Mail Ali
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,SW or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ` Not Applicable MORTGAGE COMPANY:
Name: _ _ _ Name:
Address: Address:
City: State: City: _
Zip: Phone _ Zip'
FEE SIMPLE TITLE H DER: _ Not Applicable BONDING
Name: Name:
Address: Address:
City: City:
Zip: Phone _ - Zip:
Phone:
_ Not Applicable
Mate:
Not 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 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 attorne, before commencinb work or recording your Notice of Commencement.
Signature of Owner/
STATE
OF
Swom to (or affir ed and ubscribed befor me of Physical Presence or Online Notarization
this day of 20-P by
Name of per on making statement.
Personally Known OR Produced Identification f-
T�ype of Identification Produced v'�
Of
Public- State of Florida )
Commission No 31 Oil _
REVIEWS
DATE
RECEIVED
-DATE
COMPLETED
F:ev_:,7707117
'
MARY BROWN
Notary Public -State of Flori
Commission # HH 37071
My Commission Expires
August 26, 2024
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