HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BECOMPLETED FOR APPLICATION T0BEACCEPTED
Date: PennitNumben
AIUM00 910ni lie
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Co0OOO8[Ci@l Residential UMrA1303H
2a00Virginia Avenue, Fort Pierce FL3498Z
Phone: (772)4G2-15S2Fax: (772)462'1S7D CBDGFUOdiDg____________
PERMIT APPLICATION FOR:
Mt',, ttbt-ATON
Address:
Property Tax 0#: Z2 Lot No.
Site Plan Name: Block No. 14
Project Name:
New Electrical Meter Second Electrical Meter
Additional work tobeperformed underthispennit—checkuUthatappk/:
(Affidavit required)
—Mechanical __GasTank —Gas Piping Shutters Windows/Doors Pond
__E|eutric __Plumbing __ Sprinklers __Generator �� nuof Pitch
Total Sq. FtofConstruction:
Cost of Construction: $
Utilities: — Sewer — Septic Building Height:
Sq. Ft. o[First Floor: '2-0/0
Name
Name: P09-1-P
_Yetzl&
Phone No 7_70 7-7-1 -7110
Mail:
Fill in fee simple Title Holder on next pa�e (if different
from the Owner listed above)
E-Mail
State or County License 7,3;7
Ifvalue ofconstruction is2500o,more, aRECORDED Notice ofCommencement is required.
SUPPLIV�ENI�(L �QNSTRUCTIfJN LIR1N INQRIVIP�TI��I�
..
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
_
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
Zip: Phone:
City:
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 atto_r-laey before commencing work or recording our Notice of Commencement.
o
&&ature of Cont actor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
thisZLdayof JJnAj4A 20 Sy by
Name of person making statement.
Personally Known OR -Produced Identification
Type of Identification Produced
(Sign to a of Notary Public- St a of Florida)
BURFORD
Commission No. (Seal)
FiEAYHER
�``V"i,"�, pubUo.Ststa of Florida
%N " b, Notary H 21 Sol 0
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 1U/12/21