HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: QI 121 2 Permit Number:
4
' ��'� ��" ��"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
PERMIT APPLICATION FOR: Nc_ IT
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:P . •��� Lot No.
Site Plan Name: Block No.
Project Name:��
DETAILED DESCRIPTION OF WORK;
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Addit' nal work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator Roof
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address:
Company: M6,��
Cit
Zip Code: Fax:
Phone No.
State:�L
-
Address:
City: State
Zip Code: Fax:nla
Phone No —0 . 4. 3 Q (�
E-Mail: 2
Fill in fee simple Title Holder on(,nJt
from the Owner listed above)
page ( if different
E-Mail
State County License
•• -" -1 v— — � aVU U1 inVIC, d RCLVRULU IVOUce OT LOmmencement 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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: _State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
_C2,-Zl�_ - a
Signat Owner/ Lessee/C ractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF u
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Sw or affir ) and su scrib d b � me of Physical Presence or Online Notarization
this o SJ , 20�-�-by
a I i in n 51 17-d J 0
ame of person maki tatement.
Person y Known �// OR Produc dentification
Tye f I ication roduc
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(Ilign'at6re o ar ublic- a f
Com 'ssl (S )
My Commission HH 007008
Expires 08/2512024
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REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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