HomeMy WebLinkAboutBuilding Permit Application 1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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_ ...._0._ _gin_ 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)462-1578 Commercial Residential
PERMIT TYPE: �e
PROPOSED INIPROVEMENT.LOCATI0,N
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Address: T-S"DO S Q r u ce- J r I V 6
Property Tax l D#: '340.1- 601D"D 0 9,& - Ono -� Lot No.T�-G_ , +
Site Plan Name: J o h n'5-�0(\ Block No. P�
Project Name: e,
DETAILED DESCRIPTION OF WORK '�y
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CONSTRU, INFORMAT.10N "
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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: Sq. Ft.of First Floor:
Cost of Construction:$ 1009c7 Utilities: —Sewer —Septic Building Height:
Q,WNER/LESSEE",h n" ;, ✓x„ ,pry CON°TRACTOR
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Name hel')E,e 1917 nc54-yn Name: cC/7/1�t077.G'�.
Address 6''500 5Qr-110_e z' 6ye_, Company:5+LCCLe+ Fe kyCb OXMOCLPI
City: 1=i- Pj eState:FL Address: Po 'JD SC JJP3 r0
Zip Code:
?,2 Fax: City: �_'j`I e Qa!!'+ State: 1=L
Phone No. '7°7,)-eJr7O — /PYY 21 Zip Code: 345C75- Fax:1 3035
E-Mail: Phone No 1-7,g -q-LF5'— 115/
Fill-in fee simple Title Holder on next page(if different E-Mail 6juL.kl4ence-l@be4J 6Dc ,/h ,-fl of
from the Owner listed above) State or County LicenseJL,0 010 9 7F
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.
St PPLEMEI�ITAL=CONSTR t,TION LiEiu LAW I'N'I QRMATI'pN b
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: L/ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _L-Aot Applicable BONDING COMPANY: —
of 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 thepermit 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 COMMENC ENT MUST BE RECORDED AND
POSTED ON THE JOP SITE BEFORE THE FIRST INSPECTION. IF YOU INTEN TO OBTAIN FINANCING, CONSULT
WITH YO NDE OR AN ATTORNEY BEFORE RECORDING YOUR N E F COMMENCEMENT."
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Signature ner/Lessee/Contractor as Ag nt for Owner Sig tur f Contractor/License older
STATE OF FLORIDA STATE OF FLORIDA -
COUNTY OF ill arl�40 COUNTY OF n3aJ!2ky1
The forg ing instrument was acknowledge before me The forgping instrument was acknowledge before me
this ay of_i'�/1(�y Y?!1't 20ij by thisl9day of M G1.{�Y'Q't 2011 by
meZ4,1 �ICl/i oi�o-vtGaC- __
Name of person making statement. Name of person making statement.
Personally Known Li' OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary P (Signature ofNO
Natary i a
yp Notary Public State of Florida Natary pub!{ Sta of Florida
Commission No. Dlane(Rell)&d Commission No. Jlane K Bmrlta
Ex plra�Ccmml�s22 284761 My Cammiasion GG 2es7o1
Ex12/28J202?/2Explrae 12/28/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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