HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CONL., :2rED FOR APPLICATION TO BE ACCEPTEC,- -�'i _
Date
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Permit Number: FAU
MAR 4 3 2022
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
CBDG Funding
Residential
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Site Plan Name:
Project Name:
New Electrical Meter
Second Electrical Meter
(Affidavit required)
Lot No.
EYX_
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:
Cost of Construction: $ ( n , UID
Sq. Ft. of First Floor:
Utilities: _Sewer /Septic
Building Height:
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CONT
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Address:i:w
Name:
Company:
City: State:
Zip Code: Fax:
Phone No. E-
Address:
City: State:
Zip Code: Fax:
Phone No
Mail: COM
Fill in fee simple Title Holder on next page (if different
from the Owner listed abode)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice oT commencement is requires.
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGN R/ENGINEER: Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Addr ss:
Address:
City:
State:
City: State:
Zip: Phone `l�l`ai- S•Q�
Zip: Phone:
FEE SIMPLE TITLE HOLDER: of 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 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 attorneybefore commencingwork or recordingour Notice of Commencement.
Rev 10112121
Po RECEIVED
Signature of Contract®r - or -Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF5— �"l-1
Swor to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
thiday of 202?by
Name of person making statement.
Personally Known OR Produced Id� iflication
Type of Identification Produced
(Signature o Notary Public- State of