HomeMy WebLinkAboutBuilding Permit Applicationyi All APPLICABL INF ��M��\\UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (�J —I Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding'
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT,LOCATION... .
Address:
Property
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:
Coat of Construction: $ Utilities: Sewer - Septic Building Height:
OWNER/LESSEE���
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vw.CONTRACTORS
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Name u'
Name:
Company: Aw Iu-u� ec
Address:
City: Ae'ru—
State:.
Address: ZYI// Ake& LQ.Ne
Zip Code: Fax:
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Zip Code: f,-Z Fax:,
Phone No T/v! _tea
E-Mail
Mail:
Fill in fee simple Title Holder on next page (if different'
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.
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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 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
with len er or an attorney before commencingwork or recordingour Notice of Commencement.JL,r I- JAL
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Signature of Contractor - or -Owner Builder as applicable
STATE OF FLORID
'
Sworn (or affirmed nd subscribed bef re me of Physical Presence
this day of 20�y
or Online Notarization
,
Name of person making statement.
Personally Known OR Produced entification
Type of Identification Produced
(Signature of Notary Public- State of Flor )
Commission No. (Seal)
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