HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 3'�rD �Odo Permit Number:1�
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- 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 Z
PERMIT TYPE:
O D MP M N O ON•
Address: I )
Property Tax ID #: 3 yD Z' 6 0O.00 - Lot No.
Site Plan Name: a Block No.
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gProject Name: . ,a
LEsD O O O -
Ltll JICL O6I 4/J/A PeC
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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:$ a� t)Ja Utilities: _Sewer _Septic Building Height:
p 5
Name Name. M 6KC�B
Add re s: 1061 � co C �� P Company: Ct" Dab d s U Z�G
City: ; ci i Pr' r. State: Y1 Address:33 .5W $61A0 j%I-CK Gii'ck
Zip Code: 1 10) 9 Oa Fax: City: Q atf d -hit vtc rc State: lf{-
Phone No. c� 6 1 - w 6� - H e Zip Code: 31163 Fax:
E-Mail: o opQ t< r m Phone No 5&1 373-g9NGpp
Fill in fee simple Title older on next page (if different E-Mail_�10'e /� G g" /s 1/0 � YnA J /'(?m
from the Owner listed above) State or County License �c 7TPK�l y
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 PLPMHN t •ON51RU
DESIGNER/ENGINEER:
Name: -try '
Ia 1 N J
Not Applicable
4-' '1,..'+I
MORTGAGE COMPANY:
Name:
--4ot Applicable
Address:
�[
Address:
City:
Zip: Phone Sw
State: 1
City:
Zip: Phone:
State: _
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_PrApplicable
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 IMPROYEMENTS 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."
Signature of Owner/ Lessee/Confitaaor as Agent for Owner
Sigffature of Contractor/License Holder
STATE OF FLORIDA L
OF ORI /�
COUNTY OF , LA1(I,1�
COUNTY OFSTATE
bka /+� /X 1 h
The forgoing instru egtwa acknowledged before me
The forgoing instrument wa acknowledged before me
this IL day of WY 2� by
this _ day of 20 d'V by
Name ofperson.makingstatement.
Name of person making sta ent.
Personally Known OR Produced Identification ✓/
Personally Known V/OR Produced Identification
Type of Identi i
Type of Identification
Produced L
Produced
IIl/�lJl V (f
(Signature of Notary
Public- State of Florida I
ante F rida)
Commission No.f`
� =P°alc Bt�Y of FIWCW
ifyn Il3tl Velez (Seal)
"` KAREN( NIELSEN
.o "a
,Ntary
eof Florda Public
Commission 8 GG 207484Yy
Canmiuion 6G G37771
�Exprm 12/08/2023
'0nii�°"�`
June 12,
022
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