HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
S_>`:, L.LLLr
P L 6, rti E F-"' 6� " 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: I
Address: U/ J
Property Tax ID #:
Site Plan Name:
Project Name: _
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: I
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION 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: `1 Sq. Ft. of First Floor:
Cost of Construction: $, ��i�� Utilities: —Sewer _Septic Building Height:
OWNERAE SEE:
CONTRACTOR:
Name l
Name:
Address:
Company: 1
City: State:
Zip Code: th, Fax:
Phone No. q5, C� 7 I � E-
Addres l� "
City: State
Zip Code Fax:
Phone No
TrT
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail I z let ly','
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
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
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 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 attornev before commencing work or recording your Notice of Commencement.
Signature of wner/ Lessee/C .. 'cto as Agent for Owner
STATE OF FLOR DA
COUNTY OFC(;,
Sworn to (or affirmed) and subscribed befo a me of
Physical Presence or Online Notarization
this ..L<�eday of J An 200Vby
Nam n making statement.
Personal Known OR Produced Identification
e of ication Produced
gnature of Notary P bl - State of Florida)
Commission No. (Seal) t�PYP(y•,,'
E.*�
r UBERTYA. KING
My COMMISSION # HH 120374
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EXPIRES: May 4, 2025
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Bonds !d Nomry Mk LWewbm
REVIEWS
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ZONING
SUPERVISOR
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MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21