HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: '? 10
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
PERMIT APPLICATION FOR:
Address:
Property Tax ID #:
Site Plan Name:
Project Name: 'L,2Zg__ A '�
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Lot No.
Block No.
New Electrical MeterWt Second Electrical Meter (Affidavit required)
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Additional work to be performed under this permit - check all thht app y:
_Mechanical _ Gas Tank —Gas Piping x'Shut�r
Electric Plumbing _ Sprinklers _ Generator
X W�d1ss Doors Pond
"1 Roof / ) 7_ Pitch
Total Sq. Ft of Construction:
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Sq. Ft. of First Floor:
Cost of Construction: $
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Utilities: ,Sewer _Septic
Building Height:
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Address: ( e- ��"S�-ef Company:
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Zip Code: Fax: Fax: /�%/,/+r
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City: f� i. zR State:�L-
Zip Code: Fax:
Phone No a2 5'` 6
E-Mail: hk,-,il kl i s-'.4e+
Fill in fee simple TA -Holder Holder on next page ( if different
from the Owner listed above)
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State County Lice se
If value of construction is 2500 or more, a RECORDED Notice of Comrfiencement 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 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 attorn_ey before commencing work or recording our Notice of Commencement.
-SigoKure of Owne ssee/Co ractor as Agent for Owner
STATE OF FLORID
COUNTY OF � /t•(/Z�.T-1
� Physical Presence Online Notarization
Sworn to (or affirmed and subscribed beff me of or
this�day of 20(/ by
Name of person making statement.
Personally Known OR Produced Identificat qn `'
Type of Identification Produced
(Signature of Notary Publ' - State of Florida )
Commission No. (Seal)
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Joy of Fiqt: F '•,:try Public
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Rev 2