HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1� ' �✓ ��
Date: 1;J1-;S1 IQ Permit Number:
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Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: r�ca` Y ( )
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Property Tax ID#: ��of - oa-coo L- �cx� --�► Lot No.
Site Plan Name: Block No.
Project Name:
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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: $ J��� Utilities: _Sewer _Septic Building Height:
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Name .erre ' wt•lName:
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Address: 3- c \ Company L��O.��C_�tYIC�j '
City: 1-t_ %(CSL Statef�j Address: IC71b U) Za
Zip Code: 3LACA �O Fax: City: State:_S,
Phone No, '11-1 oL " � Zip Code: 3's1g�5�- Fax: y6\-46L
E-Mail: Phone No W9) g
Fill in fee simple Title Holder on next page (if different E-Mail SnbA"O,o
from the Owner listed above) State or County LicenseC
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.
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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 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 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."
Signat fie`ovF Owner/Lessee/Contractor as Agent for Owner Sig a re of Contractor/License Holder
STATE OF FLORIDA L 1 STAT F:FLORIDA
COUNTY OF i;Ji • I COUNTY OF E
The fo going instr mens was acknowledge before me The fqqr oing instrument was acknowledge efore me
this]�day of 20,E by this L day of 201 J by
,,�A r5 we r)l
Name of person making atement, Nam o person making statement.
Personally Known OR Produced Identification Personally Known ✓/ OR Produced Identification
Type of Identification Type of Identification
Produced Produced _
___7
( t re of,,-Notary ublic-State of Florida ) (Signature o F orida)
N II�N
p�., KAREN S, h
"nYP''o KAREN S. N-IELSEN a g'�Steto of Florida-No
C _ ry
Pub al) Commission D, - blic
=aye,: +ammission # GG 207484
Commission # GG 207484 My Commiss'
'9re oP M Comm"
une 12, 2022
nir—
June 12, 2022'
SUPERVISOR PLANS VEGETATION GROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev. 2/7/19