HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO, BE, ACCEPTED
Permit Number: 03
Date:
p, . _e _ �.. - , ; D.j.. • .,._ Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential J
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
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Address: p ao �� eor C C' .�•
Property Tax ID #: Lot No.
Site Plan Name: Block No. -
Project Name:
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New Electrical Meter Second ElectricalMeter (Affidavit required)
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Additional work to be performed under this permit — check all that apply:
Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_Mechanical _
Electric _ Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construct' l�� Sq. Ft: of First Floor:
Cost of Construction: $ ,)(D Utilities: _Sewer _ Septic Building Height:: 0
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Name Name: o-j
Name
Address: Company:
City: 0 —1 p p r� State:-Vl% Address:
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Zip Code: Fax: City: � - I ' 2 State:
'' �% .s �� E- Zip Code: 3 �l Fax:
Phone No. �� r_
Mail: Phone No
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.
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NO" W-1 I,!
IN
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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: 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 commencing work or recording our Notice of Commencement. '
Signature of Contractor - or -Owner Builder as applicable
'
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of _Physical
Presence or Online
Notarization
this _day of , 20_ by
Name of person making statement.
.
Personally Known OR Produced Identification
.
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
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REVIEWS
FRONT
ZONING
-SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE.
COUNTER
REVIEW
REVIEW.
REVIEW
REVIEW
REVIEW
•REVIEW
DATE
RECEIVED
.
DATE
COMPLETED