HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l�-�• �1 Permit Number:
® CEIVC-DBuilding Permit ApplicatioFRE
Nov �
Planning and Development Services 219
Building and Code Regulation Division ST• Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE: e
PROPOSED INPROVEMENT LOCATION '
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Address: FJ 30 �e to rcl 7 P�
Property Tax ID#: ! JV 1 (10l.,VCWLQ Vo® -I Lot No. (0
Site Plan Name: OSS Block No. 15
Project Name: �c)Y-n,0 r\Q
DETAILED DESC
RlPTIQN OF WORK: -
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CONSTRUCTION„INFORMATION - = x � f .
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 La-Pitch
Total Sq. Ft of Construction: goo Sq. Ft.of First Floor: �if)no
Cost of Construction:$ Utilities: _Sewer _Septic Building Height: 1 lJ
Name 16 Yno Im Name: R.1cmVI
Address: 8 l Company: I -on 01V
City: 7177—(J-'p,1.V U Stater Address U
Zip Code: Fax: City: 1 1' State:
Phone No. Zip Code: ,_��-S^-t Fax:
E-Mail: Phone Nom
Fill in fee simple Title Holder on next page if different E-Mail YlC SC.T
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAUD INFORMATION ,,,, `
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: T 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 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 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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractorltil5ense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �{��� A(' I COUNTY OF
The for oing instru of lw�s acknowledged-,before me The for ping instrumen w cknowledg efore me
this day of V 20 L__L by this pay of 20 1 1by
11* Rrjrlc�) VCO) LH-
Nam o person making a ment. Name of person making tatementt..
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
( n to otary Public-Stat agf Iorida) KATHERINE HAVENS n re o ary Public-Sta
'Oso .pad "�� KATHERINE HAVENS
2' MY COMMISSION#GG16503 s ••..�a°
Commission L le'Se ]RES:DEC 04,2021 Commission N JJ" _',�° �� ISSION#GG165030
, " Bonded through 1st State Insuranc 'q � E S:DEC 04,2021
11A
Bonded through 1st State Insurance
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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