HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /.
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Permit Number. l �K,�(-01 QV_
Date:
LC�C�Ir
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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
PERMIT APPLICATION FOR:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
-
N'ewy ectrical Meter Second Electrical Meter (Affidavit required)
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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
on Sq. Ft. of First Floor:
Total Sq. F`?
ta�tro�::s�i t�rueti�-. � ,
Cost of Constr etil ion- - - ? Utilities: —Sewer _Septic Building Height:
a
7Na"rrne � c
Name:
_
Address: s, f "c�1L� " Cj -',°
Company:px '
��1Cit`y: : �� ;,..� , '; State.j,.`�f'.
Address:
iti .S i it F v + rl r nJ��f i�, t ,l . � ' " t?
�Zi Code � -
City: State:
«.Fax
i&e No. �(�
Zip Code: Fax:
ail: / a
Phone No
Fi14)q fee simple Title Holder on next page ( if different
E-Mail
FfroNf',the Owner listed above)
State or County License
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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.
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 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.
nature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDt�
COUNTY OF�P
Swoi to (or affirmed) and subscribed before me of __"'thysical Presence or Online Notarization
this Qk, day of Ck6, 20At by
Name of person making statement.
Personally Known OR Produced Identification
Ty e of Identification Produced
gnat re of Notary Public- S e of Florida )
Commission No. (Seal)
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,;'•. i� = COMMISSION S GG 215060
EXPIRES: De20, 2022
pGeUndawr
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REVIEWS
FRONT
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SUPERVISOR
PLA
EGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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