HomeMy WebLinkAboutBuilding Permit Application All APPLICABLP4NFO /'UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p r
Date: �3 l Permit Number: i r
ERECEIVED
Building Permit ApplicatiEB 13 2019Planning and Development ServicesBuilding and Code Regulation Divisionie County,Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 . Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
{
R'OSED 1MPK0'VEMENT LOCATION
Address:
Property Tax ID#: oL- �� �� Lot No.
Site Plan Name: Block No.
Project Name:
i S
DETAILED DESCRIPT1, OF,'aWORK
' /,ti -,;6- 6 '
prof -77" 7777
CONSTRUCTION INFORMATION a
Additional work to be performed under this permit—.check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction:r n Sq. Ft. of First Floor:
Cost of Construction:$ �o Utilities: _Sewer _Septic Building Height:
O1NNER{LESSEE ya CONTRACTOR '
°
ba
Name Name:
Address:#11F/V, .>�� Company:
p Y:
City: State Address:
Zip Code:'3,�W7 Fax: City: State:
Phone No. � �7$'� Zip Code: Fax:
E-Mail: ir�S �"'��°'�j � , oC�•� 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 HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
�� � CC7N `T11G� QN �.NItill.1W IN �RMATI ��, �� ���
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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 workand 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 Home 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 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY:'A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION.,IF YOU INTEND TO.OBTAIN FINANCING,,CONSULT
WITH YOUR LENDER OR AN-ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The fo oing instrupBMwas acknowledgeddbefore me The forgoing instrument was acknowledged before me
this day of 20L"L by this day of 20_ by
7�t 62)1 N
�1
Name of person making statement. / Name of person making statement.
Personally Known OR Produced Identification ! Personally Known OR Produced Identification
Type of Identificatii Type of Identification
Produced {, L-- Produced
(Signature of Notary Public-Sta oo�,l,a KAREN S. NI EL E(N. n ture of Notary Public-State of Florida)
rState of Florida-Nota Public
vmmission # GG 207484 (Seal)
Commission No. ,'� a ssion No.
Y Commission Ex i� .
rrrr��` June 12, 2022 ,
REVIEWS FRONT ZONING SUPERVISOR PLANS` VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW. REVIEW REVIEW ' REVIEW. REVIEW
DATE
RECEIVED
DATE
COMPLETED
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