HomeMy WebLinkAboutBUILDING PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date_ Permit Ntimber:
1
Building Permit Application
Planning and Development Services
Building and Code Regulation Division 3
2300 Virginia Avenue, Fort Pierce FL 34982 Y'
Phone: (772) 462-1553 Fax: (772) 462-1579 Commercial Residential {jl
PERMIT TYPE:
Address: j ccn c C,/Vl -A, t f- P�
Property Tax ID ;
Site Plan Name:
Project Name: _
Additional work to be performed under this perrfiit - check all that apply:
_Mechanical Gas Tank —Gas Piping _ Shutters
Electric Plumbing _ Sprinklers
Total Sq. Ft of Construction: aw
Cost of Construction: $ `f;5-0
Name
Lot No.
Block No.
Windows/Doors
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Address: U, C 4 v c"
City: State: F
Zip Code: ,3 l_�- _ Fax: fit/ j
Phone No. 7 )J-3I-S—
E-Mail: st/1A
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Building Height:
Name: rat V-�C.; cc - /-f F-w ki � K-Le. r-
Company: Cc'V f-e-ir Atu 17d r
Address: 3
City: t -� - State: PC
Zip Code: 3CFax: _FTC
Phone No
E-Mail Ailn CrTer^ ,!,GPI
State or Co ufdy License 5
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: , Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: Application is hereby made
I certify that no work or installation has commenced prior to the issuance
Zip: Phone -
to obtain a permit to do the work and installation as indicated.
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 anothdr 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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR OTI E OF COMMENCEMENT."
d.
Signature of Owner/ Lessee/Contractor as'Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA �`� STATE OF FLORIDA
COUNTY OF -t- LL1(21) `e— COUNTY OF L uk
The forgoing instrument was acknowledged before me
this 1;0, day of ) U-0AQ—) by
C1�
Name of person making statement.
Personally Known OR Produced identification
Type of Identifi'�cation
Produced )V 1,J
i Notarization vaN
signature onl
I Gti� not document cc
(Signature of Notary R. lic- State of FI i
/h
HASSNA SA'
Commission No. 6-3b
raj}.. , NOiarY Putrh; SL:
. T��M��g. MY C{lfi"IT,iS$X�7tP5
IA
REVIEWS FRONT ZONING — SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
The forgoing instru ent wa acknowledged before me
this - day of '' �� 20-2-6by
rt 0
Name of person making statement.
Personally Known oR Prod uced Identificatioi
Type of Identification
Produced vi V'L t1 t t CL.Jt- S- J i—�Xbrd c,
Iles
��/ Notarization valid;
Len�ti.i[L �C%`--- "-a�re 'only
nat docurnenf r:
e of Notary Public- State oFlwrWa 13
9FiiA 3� y
HASShA SA.NABRI,
3Q0[9Ai'a$#s on NO. afPary Public St to
3e03Z7 ` �c Commissiar c GG 34C
28_. 2023 my Corrrr, es li. 28
Jug a_;cra_tiCIir
PLANS VEGETATION SEA TURTLE MANGE RpVE""
REVIEW REVIEW REVIEW REVIEW