HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APP I N B
Date: Permit Number:
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.. ' Building Permit Application
Planning and Development Seruk-e-5-
Building and Code Regulation Division Commercial Residential V
*2300 Virginia Avenue,Fort Pierce FL 34982 i
;,, Phone: (772)462-1553 Fax- (772)462-1578 CBDG Funding
"'PERM�ITLICATION FOR: i
Address: , -
Property Tax ID#: - 41 (7 f Dbl_77MO X0 Lot No.
Site Plan Name: Block No.
Project Name: ��, i
New Electrical Meter Second Electrical Meter. (Affidavit required)
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 S Ft of Construction:q. Sq. Ft.of First Floor: /
Cost of Construction:"$ COO Utilities: _Sewer _Septic Building Height:
Name Name:'
,ddress:"7�1.`��l 7y , ��. Company:_ y
City: State:' L= -Address:
Zip Code: Fax: City: State
Phone No. E- Zip Coded Fax:
Mail: Phone No" 777 'Z--TS!
Fill in fee simple Title Holder on next page (if different E-Mail LL y
from the Owner listed above) State or County Licensees 7SQ 6A4
-77
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 MORTGAGE COMPANY: _Not Applicable
Name: Name-
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: 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 attorney before commencing work or recording your Notice of-Commencement.
Signature of Owner/Less ee/Contrac r as Agent for Owner
STATE OF FLORID
COUNTY OF
Sworn to(or affirmedl and subscribed before me of P� hysical Presence or Online Notarization
this day of 20_Z4by
Name of person making statement.
Personally Known LI OR Produced Identification
Type ofd entification Produced
Signature of Notary Publi fate of Florida) — — — — — — —
HEATHER BURFORD
Commission No. (Seal) `
o`PaYP�° State of Florida-Notary Public
'� - � ,: ��
*= Commission #GG 183217
% OF My Commission Expires
February 06, 2022
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