HomeMy WebLinkAboutBuilding permit applicationAll APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�_u l, �c �Z Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE: -
Address:
Property Tax ID #:-
Project Name: � L V-\ t'l a ncI
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C ISTRUCTION INFORMATION:
Utilities: _Sewer _Septic
Cost of Construction: $
Residential
t�Lc
E Lot No.
Total Sq. Ft of Construction:
FLOODPLAIN DEVELOPMENT PERMIT for structures exempt from Building Code that are in the
floodplain: i
Nonresidential Farm Building: _ Temp. Bldg./Shed used exclusively for construction
Mobile/Modular for temp. construction office: Bldg. involved in distrib. of electricity:
Other: Flood Zone:_ BFE:_ Floodway? Y/N 7f Y,
No Rise Certificate with supporting attached? Y/N
All other applicable state and federal permits shall be obtained prior to commencement of<
construction.
onstruction.OWNER/LESSEE,
-
OWN E Ri(LESSEE-
NTRACTOR: _
Name
Name:
Address��CSU
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Compai Gc. -t Lc6--x-2v-e-L
City:FLSY> k ��cQ Stated
Address:SC12�Lc lS s ee
City', r# _S -•Lk_i, r State: f
Zip Code: 3 -flc (S Fax:
Phone No. --n 2-, G(-)01 •
Zip Coder�S LO Fax:
PhoneNO11^ IZ..-�51�
E -Mail:
Fill in fee simple Title Holder on next page (if different
E -Mail
State d Getinty L nse
from the owner listed above)
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATfON:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE C9" -NY:
Name: /
Not Applicable
Address:
COUNTY OF Q,
Ad s:
The forgoing instrument was acknowledged before me
City:
Zip: Phone
State:
ity:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
of Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Type of Identification
Address:
Produced
City:
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City:
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Phone:
(Signaturef NoofcP
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Zip: Phone:
Ihroug ati nal Notary Assn.f//Commis(fEon�
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
rommenrine work or recording vour Notice of Commencement.
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Signature of Owner/ lessee/Contractor as Agent or wner
Signature of Contractor/License Holder
STATE OF ORI
LizCOUNTYOFORIDA
STATE OF FL <,zri\0 tlL1ti
COUNTY OF Q,
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this � day of\ tJ Ae , 2020 by
this Z5 day of �i 20�by
C lucw) Ro.(Ous
�VCc\ z4'J mcis
Name of person making statement.
Name of person making statement.
Personally Known O'L OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signaturef NoofcP
fres Feb 1, 2022
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(Signature of Notaryomm.
Ihroug ati nal Notary Assn.f//Commis(fEon�
181686
Commission No.
Commission No. ' 6h%y[omm Feb1,2022
Bonded through National Nofary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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