HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater Permit Number:
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�- • s.,.:..:__.- Building Permit Application Jm ` ^ NZ
Planning and Development Services et Luci tiY
Building and Code Regulation Division Commercial R0SidentIaIPef ing
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578,
PERMIT APPLICATION FOR:
Address:
Property Tax 1D#: Lot No. 5
Site Plan Name: o.�l
Project Name: "� �
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New Electrical Meter Second Electrical Meter (Affidavit.required)
a EMORE a
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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 Pitch
Total Sq. Ft of Construction: Sq. Ft.'of First Floor: /
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
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Name ��>�; ;_ ' a , Name:
Address: \.' C .� Company:
City: State`_ ,Address.0
Zip Code: _ -T Fax: - City: State:�C_ -
Phone No. Zip Code� Q ' Fax:
E-Mail: Phone No -Z
Fill in fee simple Title Holder on next page (if different E-Mail
from the owner listed above) State or County License( C C
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 anal 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.
Signature of Owner/Lessee/Contractor as Age t for Owner
STATE OF FLORID
COUNTY OF — LU Ga-(
Sworn to(or affirmed) and subscribed (,Xhsical Presence or Online Notarization
before me of y
thisZO day of 20 zi by
Name of person making statement.
Personally Known OR Produce Identification ✓
Type of Identification Produced C�
(Signature of Notary Public-State o lorida )
Commission No. (Seal) 7oi1qndAjLnoN-P1P!J01J'J0
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 20 21