HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO 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 A venue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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_Proprty-�l'az-1' '- Lot No.
Site Plan Name: Block No.
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. bf First Floor:
--zLos# of ConstruetieLD 5bo I� Utilities: —Sewer _ Septic Building Height:
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sx NOON 65.
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_IMMUNEzA
Name 1 '-
Name:
Address: C{ .5,�, a%Ci .,, :
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City: �� . i P.l�' ; State;„
`' State:
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Pljone No. �Z� - ��� + O
Zip Code: Fax:
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Phone No
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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.
MORTGAGE COMPANY: _ Not Applicable
DESIGNER/ENGINEER: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 attorneybefore commencingwork or recordingour Notice of Commencement.
S' nabu_rlg:.oAOwne[/aLessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirm e a d subscribed befo �jme of Physical Presence or Online Notarization
this ZZday of 20 ZClay
Name of person making statement.
Personally Known OR Produced Ide t'fication
Type of Identification Produced
(Signature of Notary Public- State f Flo ida )
Commission No. (Seal) HEATHER BURFORD
;�Pj,,:Notary Public -State of Florida
o* Commission N HH 216910
�;?OFa�, My Commission Expires
Februar
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
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MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
ev5/20/21