HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � Permit Number: a.0 0 a-O ,3
RECEIVED
Building Permit Applicat on FEB � 4 BOZO
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
PERMITTYPE:
Address:- /167 / 1 �s pR -5q
Property Tax ID#: 553;). V e2a 66L37_ Qpb _ C1 Lot No.
Site Plan Name: J Aryl ,S r00AJAd 51IL/ Block No.
Project Name: �r-rM55 (0it l"JeF//./
C721C N
Additional work to be performed under this permit—check all that apply:
qv rechanical —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:$ 3ct!55 Utilities: —Sewer —Septic Building Height:
Name 1a1-I'YI Eb D/��E Name �1_cam E
Address: I m I `v• aT jdfArl L)u op_ Company: �DU_,)
city: EXI L EXJ State:F Address: l6Z) AJ KI
Zip Code: 'J y"'I Fax: City: Orr1 AW6 &A State: F1
Phone No. 'VZ'' ZZa- /$O 3q Zip Code: 1)&q Fax: fW ?7'7- 7-74—
E-Mail: Phone No `7 " _76133
Fill in fee simple Title Holder on next page ( if different E-Mail I oq6:5�� C&'n
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 AFFIDAVIT: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
TH YOURXCRRE11,011 AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
SigUN �
wner/ ssee/Contra oras Agent for Owner Signature o Contractor/License Holder
STOR DA / STATE OF FLORIDA 1
CO �Of,J, CY COUNTY OF � �I
The forgoing instrument was acknowledged before me The for oing instrum t was acknowledged before me
this day of �{ � 20 21> by this day of F5520 z0 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification ✓ Personally Known 1/011 Produced Identification
Type of Identification Type of Identification
Produced Produced
01
c.Pirk
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(Signature of Notary Pu ic- t t r Signature of Notary I - R1dT
Notary Public State of Florida
Terri Jackson yn►et� Notary Public State of Florida
,g o
Commission No. l4e*nissionGG 133769 ommission No. Terri Q(�
or w Expires 08113/2021 My Co fbn GG 133769
OF w Expires 08/13!2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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