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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONDate: Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division COnOnlerCi8l Residential 23O0Virginia Avenue, Fort Pierce B34982 Phone: (772)462'1S5]Fax: (772)4G2-1S7O CB[}G FUDdiDg_________ | PERMIT APPLICATION FOR: / ` ' ` \ . l Address: Property Tax 0#: Lot No. Site Plan Name: Block No. Project Name: -)C) New Electrical Meter Second Electrical Meter (Affidavit required) CONSTRUCTION INFORMATION: Additional work tobeperformed under this permit— check all that apply: ' Mechanical __ Gas Tank —Gas Piping __Shutters Windows/Doors Pond � _Electric Plumbing _Sprinklers _Generator Roof Phch Total Sq. RofConstruction: Sq. Ft. ofFirst Floor: Cost ofConstruction: S Utilities: __Sewer _Septic Building Height: Fill infee simple Title Holder onnext page (if different from the Owner listed above) if value of construction is 2500 or more, a RECORDED Notice of Commencement is required. DESIGNER/ENGINEER: Not Applicable Name: _ Address: City: _ Zip: Phone FEE SIMPLE TITLE MOLDER: Name: Address: City: Zip: Phone: _ State: MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone: BONDING COMPANY: _Not Applicable Name: Address: City: 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 consu t 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 failur Record a Notice of Commencement may result in paying twice for impr en to Oorv erty Notice of Commencement must be recorded in the public records of St. L e County a n t jobsite before the first inspection. If you intend to obtain financing, consult with lender o n a fore commencing work or recording your Notice of Commencement. Signature of Con ractor - - Owner Builder as applicable STATE OF FLORIDA COUNTY OF Sworn o (or affi ed) and ubscribed before me of Physical Presence or Online Notarization this _ ay of � _, 20 -t by I Name of person making statement. Personally Known OR Produced Identification Type,of Ident' 'cation Produced _ La (Signature of Notary Public- State of FIc fid) N LANGFORD Commission No. (Seal) ©% Notary Public -State of Florida wfJ2 Comm# HH031595 Expires 12/812024 REVIEWS. FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 10/12/21