HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAil APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCCPTkD
Date: _,%-,�l Lz I'vrrrilt Number:
Building Permit Application
Planning and Development Serykes
Building and Code Regulation Dj sion Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 349V
Phone: (772) 452-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: I o
ProjectSite Plan Name: E-IGLC-��
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
la( Electric _ Plumbing _ Sprinklers
Generator _ Roof Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
R/LESSEE:
CONTRACTOR;
Name pir
Name:
Address:
Company: Aa
City: �-r _ & CL2 State:a
Address:
Zip Code: y' 6A9, Fax:
City' Stater'- _
E- Zip Code: Z Fax:
Phone No.
Mail:
Phone Now
Fill in fee simple Tide Holder on next page (if different
E-Mail ® -"
from the Owner fisted above)
State or County Licens
tf value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: — Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is g$rantingB a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Associa�tion 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
%AA+k Ion,inr nr nn ni-mmov hPfnrP rnmmencine work or recordine vour Notice of Commencement.
Signature of on - or -CKvner Builder as applicable
STATE OF FLQRIDA
COUNTY OF Y
Savor t��or affirm) and subscribed before me of
Physical Presence or
Online Notarization
this day of 204by
Name of person makin sta�ement.
Personally Known OR duced Identification
Type of ldentificat' Pr uc
r
&XI FKlI0r
Coln SHH022053
.
•i
•
4
(Signature of Not ry Public- State -of lorida)
'ar�n
Tn
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev 10712721