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 #: "� fi(��� ( S
t
Lot No.
Site Plan Name:
Project Name: V ( (
Block No.
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter (Affidavit required)
LCONSTRUCTION INFORMATION:
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:
OWNER/LESSEE: CONTRACTOR:
Name ( CXName:
Addres _
r R Company:
City:
J` ate:' Address:c�—
-6 J
-
Zip Code Fax: City: i
Stater
Phone No. i `)1 -39 (� Xj (., E- Zip Code: Fax:
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.
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:
Name: _
Address:
City:
Zip:
Phone:
— Not Applicable
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BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
• - - — •• • ••- • •-VPII�auvi i u nereuy mace to ootaln 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 jo ite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev bef nmmanrino �ninrL r.r �o. ..._.._ ni_. __ r ,
- - ....^• I C;ULJ I U I I 1r, YLJUr lvuuCe OT Commencement.
Signature of Contracto r - 0 ner Builder as applicable
STATE OF FLORI�
COUNTY OF CC,
./
Swor to (or affir ed) and subscribed before me of 1S Physical Presence or Online Notarization
this 10, day
of join .412Or 0�y
1
Name of person making statement.
Personally Known AOR Produced Identification
Ty of Identification Produced
(Signature of Notary Public- S ate of Florida
Commission No. (Seal)
DANIELLEC0NCA:\rES
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r EXPRES: sine 27, 2022 :.
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