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
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
CBDG Funding
Residential�___'
PERMIT APPLICATION FOR:��
PROPOSED IMPROVEMENT LOCATION:
Address:��
Property Tax ID #: _l� '1�1J ' t � � � � �� � ` (� ) � Ci Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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
e
Total Sq. Ft of Constructiio'nn:v Sq. Ft. of First Floor:
� Cost of Construction: $t� Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name A t�S i�Hr1SU1�
Name:
Address:
Company: -'. '
J^QC
City: i t( State: T ._
Address:
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Zip Code: Fax:
City: �'
State:
Phone No. E-
Zip Code:,
Fax:
Mail:
Phone No A D(,2
V
Fill in fee simple Title Holder on next page (if different
E-Mail �" 1
from the Owner listed above)
State or County License
it value of construction is Z500 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 Applica
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:
UWNtK/ CUNTKACTOR 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 n the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attor ev before commencine work or recording vni,r NntirP of i'nmmonr-amant
Signature o ontr for - or - Owner Builder as applicable
STATE OF FLORIyI-�
COUNTY OF
Swo to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this" day of 2Q2 by
tLUVI-1 _�t
Name of person making statement.
&.,
Personally Known OR Produced Identification
Ty e oaf Produced
( ature of Notary Public- State of Florida)
dY !��
DANIELLE G%N'�iCAI...VFS
Commission No. (Seal)•�cp
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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