HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (rnn��//��
Date: Permit a (7 PermitNumberA0103
- RFC�FD
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
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Building Permit Application St. <oeo1a t
counryent
Commercial
Residential
PERMITTYPE:
E W
Property Tax ID#:
Site Plan Name:
Project Name:
Additignal work to be performed under this permit —check all that apply:
/_Mechanical VGas Tank _Gas Piping _Shutters
_ E el ctric V'Irlumbing _Sprinklers
Total Sq. Ft of Construction: D 5 4;4
Generator
Sq. Ft. of First Floor:
E
Lot No.
Block No.
�� Windows/Doors
I/ Roof Pitch
Cost of Construction: $/ i' V-0 Utilities: _Sewer _Septic Building Height:
OWNER/L4 ESS E:
CONTRACTOR:
Name h5 Q tcG—
Name:
Addr��ess��: /� S ✓ S
Company:
city;State:1:
Zip Code: 3�r32�j_ Fax:
Phone No. �(�/ ��/U _ %tea^
Address:
City:" State:_
ip Co : Fax:
E-Mail:
7s r, e5
Fill in fee simple Title Holder on next page( if di ti
from the Owner listed above)
Brent
E-Mail
State or County License
It value of construction is 5Z500 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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UPPLEME
QLSIGNER/
Name:
AL DONS UCT ON INfO
I E R: Not pplicable
Rr; i C�� T�JC •
M ION;
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:F
O 6� AV
Address:
City: ✓
Zip: 7
State:
Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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.
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 LENDERAI AN ATTORNEY BEFORE RECORDING YOUR -NOTICE OF COMMENCEMENT."
f Owner/ Lsee/Contractor as Agent for Owner
Signature of Contractor/License Holder
7lnure
FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTYOF
The or oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of fybL_C K 2OaDby
this _ day of 20_ by
-
Name oUperson Wking statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification '
Produced
Produced
ignature of Notary P li. •
(Signature of. Notary Public- State of Florida)
IASfWINA1NGRW
Commission No. ni ''' �O�M&1nN'G�5060
Commission No. (Seal)
IRES:December20,2022
enmters
REVIEWS
FRONT
ZONING
SUPER PLANS
VEGETATION .
S_ EATURTLE;
MANGROVE
COUNTER
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19