HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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:
TN
Address:
Property
Site Plan i4011iC.
Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
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:
Cost of Construction: $ Utilities: - Sewer _Septic Building Height:
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Name —
Name:
Address: i&,v )2lUeJ4,
Company: _
City: C. State: i�
Address:
Zip Code: Fax:
City: State"
Phone No. E-
Zip Code:�1� Fax:
Phone No
Mail:
Fill in fee simple Title Bolder on next page (if different
E-Mail
from the Owner listed above)
State or County Licensee4 "
11 VCmUC U1 cuWu ULLLUn is c:)ov or more, a Ktwrcutu Notice oar 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:
Name:`
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip; Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ 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
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 recordine vour Notice of Commencement-
ature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
—
Sworn to (or affirmed) and subscribed before me of �al Presence or Online Notarization
this may of y
rA 1�nl �4 CA
Name of person making statement.
Personally Known OR Produced Identification
Type of Identificatio rod ed
(Si nature of Notary Pub ic- State of Florida)
C rgbss (Seal)
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
_ REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21