HomeMy WebLinkAboutBUILDING PERMIT APPLICATION/o11rA111 F 1KIM MMT RF r nmw FTFn FnR APPI (CATION TO BE ACCEPTED
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Building Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:.
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Address: j00 7P4,0- W 1-(-
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:C��
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New Electrical Meter Second Electrical Meter (Affidavit required)
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Additional work to be performed under this permit— check all that apply:
Mechanical Gas Tank —Gas Piping — Shutters ✓Windows/Doors _Pond
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Electric I/Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: / ,3f0 Sq. Ft. of First Floor: %� J� -0
D 00(� Utilities: Sewer Building Height: �2
Cost of Construction: $ ...3 i — _Septic
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Name: JMe fIS l?G�/rV212
-Company:
City: /mil �e�1.dE 1x; �-_ ="„-: S'tafe: 'Address:
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' ' State:
ZipCode: 3rl City: r
Phone No. ��G �%Zf✓7-b Zip Code: Fax:
E-Mail: 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 2560 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 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 con currencyreview: 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/ Lessee/Contractor as Agent for Owner
STATE OF FLORID
COUNTY OFF o
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this kko day of 20•1_1 by
Name of person making statement.
Personally KnowOR Produced Identification
Type of ntification Produced
'
(Sig of otary Public- State of Flori )
Commission No. (Seal)
�Rg111.RAHMING
WCOMM OON O GG 275060
EXPIRES: D00ffiT t 2D, 2�0,2t21e�
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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