HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABL INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
2k ZZ Permit Number:
Date:
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' ° ' Building Permit Application
Planning and Development Services
Residential
Division Commercial
Building and Code Regulation
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
A�? PPLICATION G
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Address:
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Property Tax ID # Z- GZ Lot No.
Block No.
Site Plan Name:
Project Name:
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Va -61
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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:
Gas Tank Gas Piping Shutters —Windows/Doors Pond
_Mechanical _ _ _ _
Electric Plumbing Sprinklers Generator Roof Z Pitch
_ _ _ _
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Total Sq. Ft of Construction: told ] Sq. Ft. of First Floor: I LP
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Cost of Construction: $ W U Utilities: _ Sewer _ Septic Building Height:
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Name: V
Name MET
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Addres
Company:
City AState:
Addres;:
Zip C de: 5'_2 Fax:
City: State: fl
Phone No.E-
Zip Code: Fax:
Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County Licens
t
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.
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
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Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip:
Phone:
FEE SIMPLE TITLEHOLDER:
Not Applicable
Of
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip:
Phone:
UWNhK/ CUN 1 KAGTOK AFFIDVIT: Application is hereby made to obtain a permit to clothe 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.
naf'u re o ontra or r -
ner Builder as applicable
STATE OF FLORIDA-NJ
COUNTY OF �I
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Swor (or affirme and subscribed befo a me of
X Physical Presence or _ Online Notarization
this day of
20
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Name ot person ma i g statem
Person n OR Produced Identification
Type Identific ' Pro
(Sig ure of ITa ic- Sta
orida)
Commission No.
(Seal)
�µ���¢ KATHERINE HAVENS
My COMMISSION SHH199309
EXPIRES: DEC 04, 2025
BOntlgo through 1 e State Inaurancl
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Rev 10y12/21