HomeMy WebLinkAboutBUILDING PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r) �aa. awc) Permit Number:
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
PERMIT TYPE: E L E CTZI CbN ---
Address: TSILA - 5VA V_31 +
Property Tax ID #: \ - Ste- C1011 - ODO - d Lot No. o �G
Site Plan Name:
Project Name:
Additional work to be performed under this permit - check all that apply:
Block No.
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing — Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
r p
Cost of Construction: $ Utilities
Name
Address:
City: State:.
Zip Code: _ �yq�\ Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Sq. Ft. of First Floor:
—Sewer _ Septic Building Height:
Name:_
Company:
Address: 1(�\O V1 1'10 Wa\,A mac\ .
City: State:,
Zip Code: J'���oZ fax:
Phone No �-\W- F,2L8
E-Mail -v--sN- A w\
State or County License
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.
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY,
Name:
Address:
City:
Zip: Phone:
Not Applicable
tate:
Not Applicable
to obtain a permit t0 d� file work and In5t8IIatIOn a5 indicated,
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made
I certify that no work or installation has commenced prior to the issuance of a permit.
uild the
re
St. Lucie Count makes no representation that
Owge s Asgociatlon� rulest will , bylaws oze r andpcovenantss rmit that may restrict bor pectrohibit such
which is in conflict with any applicable
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
RESULT
N YOUR
NG
"WARNING TO OWNER: YOUR S TO YOUR PROPERTY. AE TO RECORD A TNOT NOTICE OF COMMENCEMENT ICE OF COMMENCEMENT YMUST BEIRE RECORDED AND
TWICE FOR IMPROVEMENTS TOOBTAIN
POSTED ON THE JOB SITE BEFORE EY BEFORE RECORDING YOUR OUNOTICE INTE OF COMMENCEMENTNCING, CONSULT
WITH YOUR LENDER ND TO
OR AN ATTORNEY
- I
Sign at Owner/ Les e/Contractor as Agent for Owner
STATE OF F�ORIDA Cl�
COUNTY OF
The forgoing instrument was acknowledged before me
this _,4' day of ZDL_ by
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
1 ) ki> of Florida
(Signature o Notary Public iNot ry Public State are
Montep
o M2r9. E GG 214990
C1C1 _ (lam �mm3s
Commission No. �; Ef8So6I0512ono22
REVIEWS FRONT ZONING
I COUNTER I REVIEW I S REVIEWOR
DATE
RECEIVED
DATE
COMPLETED
?Signa�ure f Contractor/License HolderTE OF ORIDA
COUNTY OF
The forgoing instrument was acknowled0ged before me
this day of �L
Name of person making statement.
Personally Known ` OR Produced Identification
Type of Identification
Produced
- lc .
itlori�y Publ'cState 01
Montepare oa
c `t" Margaret E
f ssion GG 214990
M
E�� 05 2022
:nature 6f Notary Public
�Cnmission No,C- 1 � (,iti
PLANS VEGETATION
REVIEW REVIEW
SEA TURTLE I MANGROVE
REVIEW REVIEW