HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
:,'
c 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:
PROPOSED IMPROVEMENT LOCATION:
Address: ° o
Property Tax ID #: o 0Q Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ ?Iumbing
s Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ _ Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ awl 00 Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name -0006Name:
I
Addre,&j;_ i.3a (.te C&4incc C±
Company: f
City: State:Ff— _
Zip Code: Fax:
Phone No. 0- 747 E-
Address: nW1)6UW7'-U
City:
Zip Code:
Phone No
Fax:
-51
State:
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
t
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State or County License L Fe, OA
9 1
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applica
Name: _
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
Citv-
Zip: Phone:
Not Applicable
State:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as inaicatea.
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
knfnro rr%mmcnrina.n/nrk nr rPrnrdincor your Notice of Commencement.
VVIIII ICI IUCI I 011 allVl
Signature 9f Owner/ Less/Contractor as Agent for Owner
STATE OF FLORAi
COUNTY OF
Sworn, tg (or affir d) and subscribed before me of
h�Per Online Notarization
this _ I day of G. 2011 by
Name of person making statement.
Personally Known� OR Produced Identification
ntification Produced
V
na ure of Notary u ic- State of Florida
Commission No. Mal Ab&5(Seal) `''c UBERTYA KING
MY COMMISSION # HH 120374
A",
EVIRES: Wy 4, 2025
BordW TM1 NOM PUblkl U114i1MTk,
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Rev 5/20/21