HomeMy WebLinkAboutnazario permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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� Building Permit Application
Planning and Development Services
Building and Code Regulation Division [ODlOOerCi8l Residential
2300Virginia Avenue, Fort Pierce FLJ4982
Phone: (77Z)4G2-l553Fax: (772)46Z'1578 CB[)G FUDdiOg_________
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Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work tobeperformed under this permit- check all that apply:
—Mechanical __GasTank —Gas Piping Shutters VVindows/Dono __.Pond
Electric XP|umbing Sprinklers __Generator Kuof Pitch
Total Sq. FtofConstruction: Sq. Ft. ofFirst Floor:
Cost ofConstruction: $ Utilities: __�ewer __Septic Building Height:
Da
.Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail ��awmbbQ- =�Z�
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 Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
s ITM . • -
Zip: Phone:
• * 1
_Not Applicable
43WNER/ 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 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
impro o�Yn
y. A Notice of Commencement must be recorded in the public records of St.
L County ane jobsite before the first inspection. If you intend to obtain financing, consult
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Signature of Contractor - r - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF i
Swor t (or affir d and ubscribed before me of Physical Presence or Online Notarization
this ay of _ 20 y
Name of person making statement.
Personally Known OR Produced Identification
Type of ficapon Produced
UGLUXN7
N LANGFOFM
NotM Public
(Signature of Notary Public- State of Florida
HH031 s9S
`sp,ci
Commission No. (Seal)
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Expires 22//2924
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