HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CON- rED FOR APPLICATION TO B� ACCEPTED
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94", Building Permit Application �ZOZ G ® 833
Planning and Development Services 03AI3038
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:
Address: Ka
Property Tax ID #:
Site Plan Name:
Project Name: _
S
New Electrical Meter Second Electrical Meter (Affidavit required)
Lot No.
Block No.
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:
G�
Cost of Construction: $ / Utilities: —Sewer _Septic
Building Height:
<;.Ex--$i�.5a.-,'-ram
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�ompany: U4, le.
City: State;;'
Address:` a2
y:
State:
Zip Code: U Fax:
'37
/ Phone No. 7 Z 3 Z 3 960g 3 E-
Zip Code: Fax:
Phone No L -.U-7 "-
Z -73
Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail / G r �.✓ O
State or County License
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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.
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
Not Applicable I MORTGAGE COMPANY: - Not Applicable
State
_ Not Applicable
Name:
Address:
City: State:
Zip. . Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
Citv
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to,obtain a permit to'do the work and installation as inaicatea.
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 followingbuilding 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
t b f e commencin work or recordingour Notice of Commencement.
with lender or an at or orne e
ASigna
of Contractor - r - Owner. Builder as applicable
STATE OF FLORIDA
LL)c,I
COUNTY OF e
Sworn (or affirmed a d subscribed before me of
ysical Presence or Online Notarization
this day of 20,,Z 1Y
I
Name of person making statement.
Personally Known OR Produced I, en` ification
Type of Identification Produced
Ad
(Signature of Notary Public- State f Florida)
Commission No. (Seal) ,a���u,, ,HEBURFORD
ih'�pIotary Public -State o4 Florida
`•NUYP"4SCormission
-
# HH 218910
My Commission Expiresi,;,�°� February O6, 2026
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION. SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
-
RECEIVED.
DATE
COMPLETED
Rev 1U/12/Z1