HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4 - Z`'(_ 2p1 o Permit Number:
• Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: C L, C v Cwt
PROPOSED IMPROVEMENT LOCATION:
Address: 5174 SE H A&,., o, ?orL-- ,P. 34A &a
Property Tax ID#: 3q a -1 -'Ili -000ooe- q Lot No. 1
Site Plan Name: Block No. ZA
Project Name: I-
I
I DETAILED DESCRIPTION OF WORK: I
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
P, -'Electric _ Plumbing _ Sprinklers Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ � 4 J o <Z a Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name R eh&,a s LA, -.-a.' I.t c
Name:
Address:5gi4 <r �-\.AA".- 2pr:,L
Company: 3,r R. ,.r Cl,+v I c
City: ?wk S� L C k C State: FJ--
Zip Code: 3 4 q B 3 Fax: -
Phone No. -1 9 a - 233 - Y 5 3 3
Address:31ju Vie AA-Lc�F,LAb. A„ e
City: vAv,Sen 3eocu- Stater
Zip Code: "3`t9 S1 Fax:
Phone No S LC) - 9d3- S 33 3
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail ) a h S�.v . 1 . e „ rr
State or County License E2 i 3AI5•(gn
60. 3031 i
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requirea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State: _
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 Countv makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with az 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
LENDER OR AN AI IURNIT IR:tUKC KlLUK11,1IN4 TUUK NUI ILL UI
Lessee/Contractor as Agent for Owner nature of Contractor/License Holder
STATE OF FLORTt STATE OF FLORIDA
COUNTY OF f IrVh COUNTY OF Hartifl
The forgoing Instrument; was acknowledged before me The forgoing instrument was acknowledged before me
this j!� day of April . 2020 by this A� day of &qj Il . 2030 by
JaT)e_G R(-rvj) n Names 15ywn
Name of person making statement. Name of person making statement.
Personally Known V/ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
My COMMISSION 0 GG 097638 '
:ommissio June 4!20 Commission
Bonded Tbru Notary Public Undem*den s
REVIEWS FRONT ZONING SUPERVISOR PLANS V GETATI
COUNTER REVIEW REVIEW REVIEW REVIEW
.nun�� • - G 097639
COMMISSION b
7=FS:JUne . �
SEATURTLE I MANGROVE
REVIEW REVIEW
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