HomeMy WebLinkAbout2020 SLC Building PermitAll APPLICABLE iNFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
NJ�o L4t�t�U15 �`
° ����'° � ��� ° ������� �� Building Permit Appiica#ion
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:
Address:
Property Tax f D #:
Site Plan Name:
Project Name.
Lat No.
Black No.
New Electrical Meter Second Electrical Meter
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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
_ Electric _Plumbing _Sprinklers _Generator ,Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Neight:
Name
Address:
City: State• _
Zip Cade• Fax:
Phone Na.
E-Mail:
fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company:
Address•
City: State:
Zip Cade• Fax•
Phone No
E-Mail
State or County License
If value of construction is 2500 or mare, a RECORDED Notice of Commencement is requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNERjENGiNEER: � Not Applicable
MORTGAGE�COMPANY:
_Not Applicable
Name:
Name•
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE MOLDER: _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 insta{lation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with anx applicable Nome 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.
Inconsideration of the granting of this requested permit,) do hereby agree that 1 will, in al! respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
accessory structures, swimming pools, fences, wails, signs, screen roams and accessory
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvem our property. A Notice of Commencement must be recorded in the public r cords of St.
Lucie C unty and po ted on the jobsi .be€c�e-irst inspe lfxou intend to obtain fi ng, consult
with len ran nrnev hef commencing work or r cQrdine you Notice of mencement.
Signa are of Owner/ LesseeJC ntractor as Agent far Owner
Signature of icense Nolder
STATE Of FLORIDA
STATE OF FLORID
COUNTY OF ��`. ��kC`� �
COUNTY OF____ ��= �. Z ,i C.�
Sworn to (or affirmed) and subscribed before me of
Swor to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this ay of 202� by
this ay of , 202� by
Name of person m g statement.
Name of person ma
Personally Known OR Produced Ide if�atimn
�� ,,g/sta�te�ment.
Personally Known Y OR Produced Identification
Type of Identification
LL c `r
Type of Identification
Pr aced
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DATE
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RECEIVED
DATE
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