HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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:
Property Tax ID #: — — Lot No.
Site Plan Name: 1 Y } — Block No.
Project Name: n 4 IInv tn(A
DETAILED DESCRIPTION OF WORK:
New Electrical Meter _ Second Electrical Meter
CONSTRUCTION INFORMATION:
, (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: $ _&-3n J .an Utilities: —Sewer —Septic
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
i Co pan
1
Address: n�.�
-
City: StateFl
Address
Zip Code:, Fax:
City:
Phone Nto^ — E-
Zip Code -
Phone N
Mail: { 1 —}' 1
Fill in fee simple Title Holder on next age (if different
E-Mai
from the Owner listed above)
State or County Lic
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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Building Height:
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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:
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�• •r 1 �W lv a nr %- ] vn mrriuvr r : Appucatron 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 lender or an attorney before r nmmanrina le,r%Ilr nr a:....,,..._ _r
- - - --
1-1U1J1 UUI JVUM�U ur wrnrnencement.
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ignature of Owner/ Le ee/Contractor as A enf or Owner
STATE OF FLORIDA
COUNTY OF S- (A jC IC
Swoyr[*(or affir and subscribed be re me of
this I day of 20by
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Physical Presence or Online Notarization
Name of p on mak7i statement.
Personally Known OR Produced Identification
Type
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of Identification Produced
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(Signature of Notary Public- State
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