HomeMy WebLinkAboutbuilding permit All APPLICABLE INFO MOIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IT Permit Number:
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) 462-1.578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION;
Address: l ` bVe
Legal Description:
Property Tax ID#: ti ,_ 0Q - 6 1 Q - We - 0M - 7) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit heck all t apply:s
L-Mechanical _Gas Tank T Gas Piping _Shutters Windows/Doors
_Electric _Plumbing ^Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Cam- QQ Utilities: Sewer _Septic Building Height:
0. R LESS CONTRACTOR:
Name LC lcjc) LAC -��"1 Name:
Address: iroi `uekord AYlE Company: �'.t � IG 1C �-1
City: EX- p Ie( Ce State: Address: UC)Q�> Crrctr-vC, LQ+"tE
Zip Code: ��HC11S I Fax: City: Y I E C State: E
Phone No. Cod, - -ISI I Zip Code: .3LIGS Fax: 11 3701- 539 9
E-Mail: -- Phone No I -ID- o3L4- LA Gi
Fill in fee simple Title Holder on next page ( if different E-Mail CO3 al r 1a I . C orn
from the Owner listed above) State or County License CA -0- I K I C,C'C)9
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
•
S.
Uyy Pf� N�TL �G11�5TRUCTION LIEN LAW INFORMATfON
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 is in conflict with any applicable dome Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 fuil 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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.
�-
5ignatur of Owner/Lessd_e�CofAractor as Agent for Owner Signature f ontractor/Licen e er
STATE OF FLORIDA 'p STATE OF FLORIDA
COUNTY OF /11 hir3,� T r COUNTY OF I n -; s ' '
The forgoing instrumerlt.was acknowledged before me The forgoing instrume t was acknowledged before me
this;->O day of f/ 201 by this day of
x J�] ;3 =1 20 1 by
(Name p sori.ac howl dg n ��LEESTULL (Name of son a
e' iv'a� 7P&�l
LL
�zate c F ondGNa Fro-ndaGG' c39' ' 0�3MYCa�T Ex7rsjxiF 2u22 �;' 27 2022
(Signature - e o lari a ! (Signature of Nota Pur�li'c""
Personally Known OR Produced Identification Personally Known " OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.