HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: kzU Pprrnit Number:
Building Permit Application
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 CBDG Funding
PERMIT APPLICATION FOR:
2
Address
Property Tax ID#: a- of 01 3�000 V Lot No.
Site Plan Name: - Block No.
Project Name:
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 Sq, Ft of Construction: Sq, Ft.of First Floor:
Cost of Construction: Utilities: —Sewer _Septic Building Height:
Name 1')n(t Q&Vr-A40 C'4 irne:7n V11
Address:LJJ/J Company:
City: 6fT7,_.e State::V-'t_ Address: 0 A:
Zip Code Fax: City: State:
-c-_
Phone No(-_�)(_e E- Zip Code:.,I�" a62 Fax:
r
Mail: 0`•'q 'ld J' Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License eeC, 0
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/ENGINEFR: . _ Not Applicable MORTGAGE COMPANY: i 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 an 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 C ntractor-or-Owner Builder as applicable
y STATE OF'# !�
COUNTY OFi�C�1,�g�Q1T
5wor o(or affir d nd subscribed beforq me of _ Physical Physical Presence or Online Notarization
this day of 2 Y
1
i Name of person making statement.
i
i Personally Known_� OR Produced Identification��-
? pe f Ide tion Produced
ature of Nota Public-State
ALIANNY PIMIENTA
I Commission No. �jj{�j •
MY COMMISSION#HH 144727
EXPIRES:December 18,2024
Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING, SUPERVISOR j P'ANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
i DATE -- �--- T
RECEIVED
DATE COMPLETED