HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� ad Permit Number: 6
• En
CEIVED
1 6 ?020
Building Permit Applicati (IPlanning and Development Services ounty, permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
PROPOSED IMPROUfMENTrLOCATION .
Address: T
Property Tax ID#: IN Z`50 ' 0044' 00(9–9 Lot No. fog
Site Plan Name: c I/ Block No.
Project Name: r 10A 4e r5
DETAILED DES;CRIPTLON OF WORK
M_
CQNSTRUCTION INFORMATION:
Additional work to be performed under this permit–check all that ap y:
_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: $+i 7�j dl� Utilities: —Sewer _Septic ` Building Height:
OWNER/'LESSEE " CONTRACTOR
1 Name: 11
Name � loot 5
Addre i- Company: r
City: ('u I I state:-34Addres: �
Zip Code: ��i� Fax: City: State:
-51
Phone No.�7 0#0 61g7V Zip Code: Fax:
E-Mail: Phone N 2-
Fill in fee simple Title Holder on next page(if different E-Mail act yr Dn
from the Owner listed above) State or County License cv,
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.
•r
:SUPPLEMENTAL CONSTRUCTION.LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
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 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
H YOURKNDER OR ftWATTQ1RNEY BEFORE RECORDING YO_UR-NOTICF,OF COMMENCEMENT."
rzgn e f Owner/Lessee/Contracto for Owner Signa re of Contract License Holder
TATER ORI na STATE OF FLORIDA
COUP OF COUNTY OF
The for g instrme t was acknowledged before me The forgoing inst ume t was acknowledged before me
this day of 201V by this day of 20-PO by
- r
Nam of personjnakingstateT6ent. Nam of person aking sta en .
Personally Known Fro, Personally Known aduced. iga
Type of Ident'ficati � '`_ MY COMM Type of Ide tiff atiQn ®' :* INYCDMMISSION#G�2
Produced COMMISSION ,2022 Produced (i `'�••...P°`� EXPIRES:De r28,2022
28,2022 J
.,��P .°`'•� BoeM rl ru Nomry PLft ur&r vrlteta ry Publk Uodeiw ,,, JJJ
(Sign ure o ota ublic-State of Florida) (Sign uNota ublic-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED.
DATE
COMPLETED
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