HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �1 J
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Building Permit Application
IPlanning 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:
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Address: G �j13 t�i�S, t✓e �f�,•-T �v�G �- -
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Property Tax ID#: l — Lot No.
Site Plan Name: Block No.
Project Name:
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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
_Electric Plumbing _Sprinklers _Generator Roof Pitch.
Total Sq. Ft of Construction: . Sq. Ft. of First Floor:
Cost of Construction:$_ / p aZ Utilities: .—Sewer Septic Building Height:
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Na me, 1-. 6 TT�-4�Q Name: ,t ,I.Q1;
Address:_2zi,6,4 2 f`ocx y i s e4V e Company: ,,L,6crr
City: t'pv^': �i Pert State: i't. Address:__
Zip Code: 2`I q ,1 b Fax: City: For i 4 1 I State:���
Phone No. . Zip Code: . 3 ti f Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
i from the Owner listed above) State or County License 9G 13 O a 9,;,L!3
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. J J
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 coveriants;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 1 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 re.cording your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to or affirmed) and subscribed before me of Physical Presence or Online Notarization
this of 20 by
Name of person maw king to/temen .
Personally Known s OR Produced Identification
Type of Identificatio�roducd
(Signature of N GHN
ELLEN VA
:`o`er JB� �state of Floti gg++--Notary Public
Commission No. __ - mis�io�'+P� 270079
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ly Cbi'nmission Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2 21