HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' 2O Permit Number: 002 r
RECEIVED
Building Permit Application.;
Planning and Development Services FEB 2 1 202
Building and Code Regulation Division ST. Lu ounty, Permittinal
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
Address: v L
Property Tax.ID#: "� d 5 r ( Lot No.
Site Plan Name: Block No.
Project Name:
S \ W
Additional work'to be performed under this permit-check all that apply:
_Mechanical _Gas Tank, `* 4:, _Gas°Piping I hutters" Windows/D.00rs
_Electric _Plumbing -Sprinklers _Generato,'r =Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
Name c��`b`��_ 'moi Name: , ZG\,-►t`�"
Address: �� �� ._ kAl
Company:
City: State:� Address: rJV1 _�j'�
Zip Code: Fax: ' ' City: `S Stater
Phone No. �� J - `f O Zip;Cocle:
LJ Fax:
E-Mail: .. ,. .. ,.� ..v Phone No
Fill in,fee simple Title Holder on next page(if different E-Mail \'L'L1Mr�-�• ^/GVNna. o C
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.
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 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 an,d review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree.thaflwill;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
WV4 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING_Y NOTICE OF COMMENCE? NT."
Zre of Owner/Le / tractor as Agent for Owner Signe of Contractor/License H�dei,,
SdATE OF FLORID STATE OF FLORIDA
COUNTY OFA �,',)�1� COUNTY OF nz
Thef oing instr t as acknowledgedefore me The for oing instru w s acknowledg efore me
this 15 day of 2t by this day of 2 by
30 ZZ Ig i
Name of person making st ement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identify Type of Identific`fa� _ y�
Produced Produced 1 & &
A-A 1A
(Signat re of Notary blit- tate of Florida) (Sig
rar//, KAREN S. NIELSEN
los v ,,
Co i� it o. KAREN S.-NIELSENSe ) Com i e State of Florida-Notary Puq )
ooaNotary Public tatcommission G 207484
'_* •c Commission # GG 2.07484 %'•E `o°; My Commission Expires
4, 2022
1 / 111
rrnu"` J ne 12, 2 22
REI SUPERVISOR PLA Vtk3t IAII UN"""""`N1TEwTrURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
L
2/7/19