HomeMy WebLinkAboutBuilding Permit ApplicationAll, APPLICABLE INFO MUST BE'COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Application
Planning and Development Services
Residential
Building and Code Regulation Division Commercial Cial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPCICATION FOR:
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Property Tax ID #: 34IL"5aO"9301 -(Vt) _ O Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit - check all that apply: r
)�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: �ot Utilities: —Sewer _Septic Building Height:
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Name: �yD�2 A1A--
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Fill in fee simple Title Holder on next page ( if different
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State or County License 513
from the Owner listed above)
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.
Mail I,
MORTGAGE COMPANY: _ Not Applicable
DESIGNER/ENGINEER: _ 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 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.
for Owner
Signature of Owner/ Les ee/ ntractor as Agent
STATE OF FLORIDA
COUNTY OF,��,��,�
Sworn to (or affirmed) and subscribed b o e me of `Physical Presence or Online Notarization
this- day of a 12Q6 by
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Name of person making statement.
Personally Known OR Produced Identification
Type ottdentification Produced
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(Si o...
Notary Public StateW Florida) LASHAHNAINGRAM•RAHMING
MYCOMMISSION # GG 275060
Commission No. (Seal) b; EXPIRES : December20, 2022
Bonded Thru N otaty Public Ucdemrllors
REVIEWS
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ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW .
REVIEW
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DATE
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COMPLETED
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