HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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) 462-1578 Commercial Residential
PERMIT TYPE:
Iress: L41(y N 3 6 SI, FOIJ Pi e'rC E EL 39T-1.7
perty Tax I D #: 24(g - &0I — OC) i a - 00O -' Lot No.
Plan Name: Block No.
ject Name: c— c- In
'Additional work to be performed under this permit —check all that apply:
YMechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $
ESS'fE:I'll 15311
Is
Sq. Ft. of First Floor: _
Utilities —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height:
QWNEft/Le' ,CONTRACTOR'
f s �04
Name IU jr I
Address:�zasw W P1e 5a L Vy,
Name: Ir
Company: AAA AC n, ua Wu oes
City: Pov5bEiJ Luct 0 State:�L
Zip Code: 2,ggg, Fax:
Phone No. S/
Address: vG �``
City: ROVA, ( Pa 1% EWtiC-c ] State: AFL
Zip Code: 3 �1 1/ Fax:
Phone No O 17-
"�2
E-Mail: 4Y7t�FLiciccta vC��F�i°Y1GtI . GL7i'Y�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail &6111L9S0rXftA •
State or County Li ense
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.
T
S,UPRLE
DESIGNE
Name:_
Address:
City:
Zip:
NGINEER: _ Not Applicable
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
ORIVIATION
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
BONDING COMPANY
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
_Not Applicable
COWNER/ 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMFNCFMFNT"
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Signature of Ow , / Lesse ntractor as Agent for Owner
Si`gfa1t4fof Contra r/License Holder
STATE OF FLO(Z21D
COUNTY OF Lucie
STATE OF FLORIDA ,
COUNTY OF_ t ucif
al n-
_,�¢ih e
The forgoing instr�.urent was acknowledged before me
bey
The forgoing instrument w s acknowledged before me
this `Z7day o NOV& M , 20 is by
this 2-Tday of rJOVeN1 0&V 20A by
Porp(D�rve�-
e of pAorf making statement.
Name of person making statement.
Personally Known .� OR Produced Identification
Personally Known / OR Produced Identification
Type of Id :, entificatv;
Type of Identification
Produced
Produced
(Sign a Notar Public- S t f I r-da)
(Sign i
• Notary Public State of Florl
Commi g n ..;_ n� 1de eal)
Ntltary Ubli¢ State.ot
Comm �� r BeOtsia Beretervide. S )
My Commission GG 244869
' 234�4089
Ex Tres 08/01I2022
e Exp es OQ(A �Q�
REVIEWS
SUPERVISOR
PLANS
MANGROVE
FRONT
ZONING
O�a0�d0
VEGETATION
SEA TURTLE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
nev. L/ // 17