HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLL'= .'�2 FOR APPLICATION TO BE ACCEPTED r
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Planning and Development Services 03AI3038
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
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Address:
Property Tax ID #: on--7 Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical 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 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction: $<(.�(6� Utilities: —Sewer —Septic Building Height:
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Name
Name:
Address:
Company:
City:State: e�
Address:
City: State:
Zip Code: _2_-,'2�LQ_L Fax:
Phone No.—\--'Q, C)C—\\ E-
Zip Code: Fax:
Mail:
Phone No I
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License
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from the Owner listed above)
IT value or construction is zSuu 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.
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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 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 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.
signs ure o on ractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF Ly c .L J
Sworn t or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of 5'p�,lt 20 ZJ.I;y
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced 7by
( ignature of Notary Public State of Florida)
,�PaY'r'ie, HEATHER BURFORD
Commission No. (Seal) 20 ",A -,State of Florida -Notary Public
y ee? Commission # GG 183217
i ih�uP F`�P; My Commission Expires
,
February 06, 2022
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