HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number: ( u/U `
Date:
Building 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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Address: l y''►-� %�
Property Tax ID #: Ug� Lot No.
Site Plan Name: Block No.
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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: $ t)o - Utilities: _ Sewer _ Septic Building Height:
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OR
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Name:
Name r' ; ''t:; r .:'> •,.:_
Address: ® =
Company:
City: C" ` -'. ` ..,� :.State: i'
Address:
City: State:
Zip Code: 3 K& 2 Fax:
Phone No.-�?�l'-5to 70 E-
Zip Code: Fax:
Mail % co
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County 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.
DESIGNER/ENGINEER: _.Not Applica
Name: _
Address:
City:
Zip:
IT.""
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that nawork or installation has commenced priorito 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 an attorney before commencing work or recording our'Notice of Commencement.
klignare
of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this ' day of 20_ by
Name of person making statement.
�'
Personally Known OR Produced Identification
Typ f Identification Produced
(Snatu e of Notary Public- Sta of Florida)
Commission No. (Seal)
`'` Yg� , �SHMNAINGRAM-RAMMING
"
' • GG 27%60
MY COMMISSION #
FJ(PIRES: December 20, 202 2
+, P Thru Npq�y public Unde►writets
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE.
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW.
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21