ST. LUCIE VILLAGE PERMIT APPLICATION
Must be signed by owner/ Agent/Lessee:
X
(Signature of owner/agent/Lessee)
has produced as identification. ID. Type
Notary Signature:
by personally known to me or who
subscribed before me this 20
State of Florida, County of Affimed to and
X
(Signature of owner/agent/Lessee)
has produced as identification. ID. Type
Notary Signature:
by personally known to me or who
subscribed before me this 20
State of Florida, County of Affimed to and
Contractor:
MORTGAGE COMPANY:
1. WARINIG 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 and posted on the job site before first inspection.
2. lf you intend on financing, consult with your Lender or an Attorney before commencing work or recording your Notice of Commencement.
3. Application is hereby made to obtain a permit to do work and installations as indicated. I certify that no work or installation has commenced prior to the issuance
of a permit and that all work will be preformed to meet the standards of all law regulating construction in this jurisdiction. I understand that a separate permit must
be secured for Electrical, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters, Tanks, and Air Conditioners, ect.
4. OWNER AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will work will be done in compliance with all applicable laws
regulating construction and zoning.
Application Approved By:
F.S. 713.135 (6)(a)
Local Contact
Phone:
State License Number:
OR Municipality:
License Number:
Qualifiers Name
Address:
City:
Zip:
Contractor:
Phone: Email:
JOB COAST (required on all applications)
(Notice of commencement required when over 2500, or 7500 for HVAC)
Value of Improvement: $.
Date
SCOPE OF WORK(PLEASE BE SPECIFIC):
City:
State:
Zip:
Phone Number:
Fee Simple Holder Name (If different than owner):
Address:
Legal Description:
Parcel Number:
OWNER/LESSEE:
Phone:
Email/Fax:
Permit Number:
Job Site Address:
City:
State:
Zip:
Service & Meter location secured from FPUA: Yes
No
YES
NO
(If owner Builder affidavit must accompany application)
OWNER BUILDER OR CONTRACTOR
BONDING COMPANY:FEE SIMPLE TITLE HOLDER:
Not Applicable
Name:
Address:
Phone:
City:
State:
Zip:
DESIGNER/ENGINEER:
Not Applicable
Name:
Address:
Phone:
City:
State:
Zip:
Not Applicable
Name:
Address:
Phone:
City:
State:
Zip:
Not Applicable
Name:
Address:
Phone:
City:
State:
Zip:
