HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICAP-.'.00 MUST BE COrMPL ®R APPLICATION TO BE ACCEPTtu-'
Date: FEe Permit Number:
20�2
O permittincounty
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial _
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address:
Property Tax ID #:
Site Plan Name:
Project Name: _
Electrical Meter
�0
13 aq_
Second Electrical Meter
Residential X
(Affidavit required)
Lot No.
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: //nn Sq. Ft. of First Floor:
n` 6 V
Cost of Constructio? 000 Utilities: —Sewer .—Septic Building Height:
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City: Let,,��{'Ce State:
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p Code: 8 4 J Fax:
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Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
il: I ✓i e— YIJ
F�i,l�fn fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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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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
i IanrJor nr an nttnrnav hafnra rnmmencinL7 work or recordine vour Notice of Commencement.
signature f Co gt6r - or - Owner Builder asepplicable
STATE OF FLORIDA
COUNTY OF
���
Sworn to or affirme and ubscribed before me of Physical Presence or Online Notarization
ZO r�o�Sq'
this ay of
nto%RQ_ bilk(
Name of person making statement.
Personally Known roduced Identification
Type o tificatio roduced //
7ia�t re o r_y__Public- State of Florida)
Commissi 11 1 EtIL HN
,,lri rrri,
State of Florida -Notary Public
# GG 270079
Commission
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21