HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Site Plan Name:
Permit Number:
Building Permit Application
Project Name: S ns„; 4A Lakes I
Commercial Residential X
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: -I
MM,V _
i�r •� 4-
LXNWAFZA. ... • .
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical
X Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ i4 DDO _ JW
_ Gas Piping
_ Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name W l nne- �J;n nrn
. n;
Name: (� hr. sfto�_
Address �$ODd U �.T
Company: ern t CICr4 l;C.
City: nrt -53 Lt.•ci o- State: FL
Address: iL L O 5k/ n'l,Lr_Ko_ P ve.
Zip Code: meq$” 2 Fax: 772 -boy - D1 S�a
City: Pof+ 54 &cie_ State: FL
Phone No. -72a - rd 7 r - 3 o 11
Zip Code: V S 3 Fax: 7 72 - 2oy - 2l 80
E -Mail: h#-Vear rr INDAPA isb 12es 5M
Phone o N 7 27 - 7 OA'- 4 4 6 ro
Fill in fee simple Title Holder on next page ( if different
E -Mail c kri s e SrJe 1,-ke
,CA 5 r corn
from the Owner listed above)
State or County License 68, 31751
.. .. wa. —, .0'P& ul IIIu1C, Cl n[%.vrtU[u IVOLICe OT LOMmencement Is requiretl.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable
MORTGAGE COMPANY: X Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
BONDING COMPANY: X 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
11-A ta
Signature of O ner/ Lesse
Con or as Agent for Owner Signature of Co ractor/Licen Hold
STATE OF FLORID // ` STATE OF FLORIDA
COUNTY OF jZ C��� r COUNTY OF �� L U
Swpfh to (or affirmed) and subscribed before me of Sw to (or affirmed) and subscribed before me of
Physical Presen Online Notarization��Pj�sical Presenc or Online Notarization
is, day of (," L 2020 by t is 2-� day of 2020 by
Name of person making statement. Name of person making statement.
Personally KnownOR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identificati n
Produced y Produced
(Signa ure of N� arida (SignatureWN�{plorida)
TARY PUBLIC ARY PUBLIC
Commission` STATE OFFLORIPSeal) CommissioFFLORIDA(SeaI)
Conxn# G4262T80 m# GG262780
1.
M—ft 012812092
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 6/20