HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION T0BEACCEPTED
Date: Permit Number:
u Building
Permit Application
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Planning and Development Services
Building and Code Regulation Division COOOm2PCi8| Residential
230UVirginia Avenue, Fort Pierce Fl349D2
Phone: /772\462-15S]Fax: (772)462'1578 CB[)G Funding
PERMIT APPLICATION FOR:
ML
Address:
Property Tax |D#: Lot No.—
SiteP|anName: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
required)
Additional work to be perfonmedumderthbpermit—check all that apply:
__K8echanko| __ Gas Tank __ Gas Piping Shutters Windows/Doors Pond
__Electric __Plumbing __Sprinklers __Generator Roof Phzh
Tota|Sq. FtofConstruction: Sq. Ft. ofFirst Floor:
___
Cost ofConstruction: $ Utilities: —Sewer __5epdo
Name
Address:
City State:___
Zip Code: Fax
Phone No.
Mail:
Fill hnfee simple Title Holder mnnext page (if different
from the Owner listed above)
Building Height:
Name:
_ Company:
Address:
City: State:____
G- Zip Code: Fax
Phone No
E-Mail
State or County License
Ifvalue ofconstruction is 250Oormore, aRECORDED Notice mfCommencement is required.
Ifvalue mfHAVC is $7,5OMormore, aRECORDED Notice ofCommencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
_ Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
_ Not Applicable
State:
BONDING COMPANY: Not Applicable
Name: _
Address:
City: _
Zip:
7IT41=
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 commencinE work or recording vour Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORID
COUNTY OF t- �,, ,6 C' 11
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
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Commission No. ig-6 (Seal)
Notary Public State of Florida
.10
'iN, Amanda P Sanderson
GG 211256
MY commission
Expires 04/25/2022
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Rev 10712/21