HomeMy WebLinkAboutBuilding Permit Application All APPLI ABLE.INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 22- Permit Number: r
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° Building pp 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 CBDG Funding
PERMIT APPLICATION FOR:
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Property Tax ID#: � �/ ;� �� �� v7/D Lot No.
Site Plan Name: �,,// Block No.
Project Name: /li 1,4
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New Electrical Meter Second Electri 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
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Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq..Ft of Construction:r n Sq. Ft. of First Floor:
Cost of Canstruction: $ 1 (l. Utilities: _Sewer _Septic Building Height:
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Name NI)5� S Name: �S
Address: U d Company: I }'
City: S State: li Address:
Zip Code: Fax: City: r ! �/_ State:
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Phone No. /n1 � ' Y E- Zip Code: 3`� L 1 Fax:
Mail: S fit, Phone No
Fill in fee simple Titl older on ext page (if different E-Mail il fiff t110 1)_h !�
from the Owner listed above) State or oun License
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.
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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.
Sig ure of nt ctor-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to or affirmed) and subscribed before me f �" resence or Online Notarization
this day of_ t 20
Name of person making statement.
Personally Known OR Produced Ide catio
Type of entification Produced
ELLEN VA o aH Public
(Signs ure of No` taf�g Artde�� ��2 jy commission Expires
tob8r22+ 202
2
Commissi No.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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