HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICA LE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number:
4S
4c'� l�oO"-4 Building Permit Application JAN y �02�
Planning and Development Services t p Co n yent
perm Lucie
Building and Code Regulation Division Commercial Residential
,2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
/ill
PERMIT APPLICATION FOR:
Address: '/� 7:1-Z--' �= 4v f -i or 7 . G� �/, fit, 1�'g1� S 7 % 7 7 /�oo
Property Tax ID #: l � � `— (200 — it Lot No.
Site Plan Name: Block No.
Project Name:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
,Electric X Plumbing Sprinklers _ Gen'erator _ Roof Pitch
Total Sq. Ft of Construction: '/ rregv�'01'4 -1 Sq. Ft. of First Floor:
Cost of Construction: $ 7e ,ul D Utilities: —Sewer _Septic Building.Height:
pmw $° 7' _ }y�P_. �, ( R c`. J'� .^
OW�NsR%LSSEE i� a , aCO;(UT
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�A.CTOR:��
Name
Address: O
b
Name:
Company:.
City: a
Zip Code: Fax:
Phone No. ; ®— i(
State:tV
7
Address:
City:. State:
Zip Code: Fax:
Phone No
E-Mail: u eewt
Fill in fee simple Title Holder on next
from the Owner listed above)
age ( if different
E-Mail
State or Count License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: `Not Applicab
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Alamo•
Address:
City:
Zip: Phone:_
State:
Not Applicable
MORTGA E COMPAN
Name: A
Address:
City:
Zip; Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip; Phone: -
',NoCpp�able
ANot Applicable
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.
Agent for Owner Signature of Contractor/License Holder
Signature of Owner/ Lessee/Contractor as g
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF - COUNTY OF
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
'Il`� 2020 by this day of 2020 by
this L day of -XQ=a�
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
r. Produced Produced
� „^ �'..—.T—
(S gna ure of Notary Public K REN S. NIELSE
S to-Rf Florida -Notary P blii
Commission No. `_ .= Mission # GG 20746�
My Commission Expires
June 12, 2022
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
ev.
re of Notary Public- State of Florida )
n No.
SUPERVISOR I PLANS I VEGETATION
REVIEW REVIEW REVIEW
(Seal)
SEATURTLE I MANGROVE
REVIEW REVIEW
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