HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:7'l!�`� Permit Number: �909-0V lJ(
•
- Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2,300 Virginia Avenue,Fort Pierce FL 34982 1100"
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE: e 'Y7.-AlAte;�)L
PROPOSED IMPROVEMENT LOCATION: r
Address: 0 �amw J
Property Taxt�� Lot No.
Site Plan Name: A_[ qae- S $ Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
H
CONSTRUCTION INFORMATION:
Addition l 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:J
Cost of Construction:-$ Z.900'�P Utilities: —Sewer _Septic Building Height:
OWNER LESSE : CONTRACTOR:
Name Name:
r j �►7
Address Company: ' l .7n
City: State:_ AddreV:rz'103 -ril/
Zip Code: r{�J� Fax: City: State:
Phone No. Zip Code: W�0 �aFax:
E-Mail Phone No 5 $Q3
Fill in fee simple Title Holder on next page(if different E-Mail s
from the Owner listed above) State or County LicenseCl��yJ
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 theppermit 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 ' . 1 STATE OF FLORIDA II
COUNTY OF 1,`�,, .,�.JCIE, COUNTY OF _l - I I I
The forgoing instr ent was acknowledge efore me The fir °ing instr ment as acknowledge before me
this day of A 20 by this �- 1 day of 20 by
NJ as IZZ
Name of erson making statement. Name of pers n making statement.
Personally Known OR Produced Identification' ✓/ Personally Known OR Produced Identification ✓/
Type of Iden ' do Type of Identification
Produced l� �� Produced Tru
t,10 AA Ini
S
(Signature of Notary_ Public-State of Florida ) (Signature of Not
�,WIII/,, KAREN S. IELSEN
Commis °�e%7KARENIstel :o`°� .B��,State of Floiid��No ry Public
NIELS ]UPERVISOR
Commission No. missio �3207484
ary Publ ` My Commission Expires
# GG 207484
2022
ie 12, 2022
REVIE PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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