HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date: Permit Number:
Building Permit Application #4R 0Planning and Development Servicesng 22pz®
Building and Code Regulation Division 5t1� $ vunt`nenr
2300 Virginia Avenue, Fort Pierce FL 34982 y
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential tz
PERMIT TYPE: F LF7- C-TP i C�1�I L
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Address: �) �)� �, 34 k 2.
Property Tax ID#:_3W O= ri Lam"'( 1= [�l J"oZ I j Lot No.
Site Pian Name:_ -7_R0Q C q L ES L 65 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/Dooes
_Electric _Plumbing _Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ L00 Utilities: —Sewer —Septic Building Height:
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Name DQM ,9Lb HF-AE127- Name: _
Address: '9 3a- 3EA OWCH Phut✓ _ Company:
City: eT', 'P!1✓IZGE' State:FL, Address: ) W. A L")
Zip Code: 3 499ol, Fax: City: le-r, c L State-A
Phone No. -119- 14(oq' l Zi Cod�8o� .Fax: �1 1-'q 6 �...
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E-Mail: Phone No `77 - -q(01 02po-
Fill in fee simple Title Holder on next page{If different E-Mail pngiM �C) .
from the Owner fisted above} State or County License C-0- 1,9zo !6 q
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. j
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 usel
"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 AeOwner/
Lessee/Contractor as Agent for Owner Sign tur of Contractor icense Holder
STATEORIDA7ytl STATE OF FLORIDA C�-
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instr me twas acknowledged-before me
this ?� day of d 20 Z-qy this clay of 20_ y
Name of person making statement. Name of person making statement. �— - -
Personally Known OR-Produced Identification Personally Known OR Produced Identification'
Type of Identification (� Type of Identification
Produced ��- Dc" Produced OL
AUGHN "t t
(Signature ofNotary a �_>et®€ � (Signature .�� a;Pu icC � a
Com ori a-Notary Public s=State of Fl N VAUG
mission
Commission No. %%P," My CorFie� GGX700�9 Commissi F oma: comm; °fjda-Notary� �'�
October 22. 2022 es "tt t�" Y Commis#GG 270078 c
Octoberm
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION wawEA TUR ANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 217119
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