HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: OZ
7
1�/
• � RECEIVE®
Building Permit Applicatio
Planning and Development Services MAR 0 5 2020
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST. Lucie County,
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residen �'� Permitting
PERMIT TYPE:
OPOSh01' PRO EMHNT LOCATIQN:
Address:
Property Tax ID#: Lot No.
Site Plan Name: /� // 1 Block No.
Project Name:�/'1/��ZZ d Uu xly�i�' CLA / a, 45_
OETAFLEO OE��CRiPT10 01= OR
CONSTRUCTIONI INFQRMATID
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:$ Utilities: _Sewer _Septic Building Height:
OWNER LESSEE: 7-- 7
Name 1v LS, ow✓� :Address:City: �jdZ . 7 Staeddress: =:5" ey
Zip Code: Fax: City: eb' F State:`
Phone No. ,�Ci` .,J p�� ��-Z— Zip Code:) /-/9J-j Fax: /y7-VA�/2/9
Phone No �7;�f3,l�/
Fill in feesimple Title Holder on next page(if different E-Mailrlf}n/u�9 /e/LP'6f�S P. = fff.5�
from the Owner listed above) State or County License,' k_- yS-72 6'6
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.
U ' P EM NTA!CONST UCTI4N t LAW ! FO A t0 : ,
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _NotApplicable
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 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 98 AN ATJORNEY BEFORE RECORDING YOUR NOTICE OF COMME EME ."
Sig ature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Lucy COUNTY OF I
The fgxgoing instrument was 4cknowledged before me The for oing instru nt was acknowledged before me
this day of Y 20 by this day of 20_f by
LAN +e �K/Ht -61 r
Name of person making statement. / Name of person making statement. /
Personally Known OR Produced Identification V Personally Known OR Produced Identification ✓
Type of Identific Type'of Identifica .
Produced Produced [J
(Signature Q# 'r *^`^=f='^«' (Signature of f Florida)
%k pi", KAREN S. NIELSEN o`� ly"w" - KAREN 1�J
Commissio _ B`�;State of Florida-NgSg8flyublic Commission N ;�_� �`s_State Florida-f� 6PEN
*= ommission # G 20 484 ar Public
�?If.OF"ppb My Commission Expires " omi
12, 2022 ,,,o°�� My Cor*�ron.#GG.207484
June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIO ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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