HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE IPJFO MU PT BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Date: Permit Number: e h
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`--- .- Building Permit Application DEying
Planning and Development Services S
Building and Code Regulation Division Commercial
Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 46.2-1578
PERMIT APPLICATION FOR:
Yk
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0110010
Address:
Property Tax ID#: Z'UI 7)0 — 2-11 — Gl'iCJ1 �1 � Lot No.
Site Plan Name: Block No.
Project Name:
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�.Met`e�r _�_New Electrical Meter Second Electri (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:
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111 �'F u }
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-11
Name Name:
Address: w �`" - Company:
City: / / State: Address:
Zip Code: Fax: City: State:'
Phone No. 0r (/�' � � Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page( if different E-Mail from the Owner listed above) State or County License
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.
ADESIGNER/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 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.
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 jobs' e before the first inspection. If you.intend to obtain financing, consult
with lend an atto e before mmencin work or recording our Notice of Commencement.
Signature w s ontr r gent
STATE LORIDA
COUNTY OF
Sworn to(or affir d)and subscribed bef re me of _Physical Presence or Online Notarization
thisQlay of 2 (( by
Name of"rson making statem nt.
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Type f Pduced 3S R
Personally Known ORP ed Identificati C 8
EXPIRES:Yiacch 6,2C)23
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(Signature of N tar Public-State of Flori a) "
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2 21