HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 Permit Number:
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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)462-1S78 Commercial Residential
PERMIT TYPE:
Address: 6z (S
Property Tax ID #: ���� �?JZ— oolln�6 — Oc(__ Lot No.
Site Plan Name: Block No.
Project Name:
� DETAILED DESCRIPTION OF WORK: — ---- -- ---— = _=
0—04M
Additional work to be performed under this permit-check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
V Electric _Plumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ _�_ Utilities: Sewer ___Septic Building Height:
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SSEE: CONTRACTOR. e
Name U0, oLr 5 Name: S
1 Address: Z i Company: IL
City: le G G State:t-L Address: � - 1 La
Zip Code: 3yq`) Fax: City: �. °��fC Stater
Phone No. ��Z_ 6C)k -9�71 15 Zip Code: 349C; _ Fax:
E-Mail: Phone No
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Fill in fee simple Title Holder on next page( if different E-Mail e Lkt'C--
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from the Owner listed above) State or County License
i
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 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 1 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 HE JOB SITE BEFORE THE FIRST INSPECTION. IF YO D TO OBTAIN FINANCING, CONSULT
WITH R E ER OR AN ATTORNEY EFORE RECORDING YO NOTI OF OMMENCEMENT."
I
re f 0 ner/Lessee/Con actor as Agent for OwnerWt Contra for/License Hol r
S ATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF li
I
The forgoing instrume ,t was a knowledged before me The forgoing instrument wa acknowledged before me
this__�___day of 19P 21 by this-L day of I 20 by
Ba
reo
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of lclentificg-tian Type of Identifi +ten
Produced Produced
�.__----_-
(S .; "� )
�1pPY PLB�i �' YP '� NIELSEN
State of Florida-Notary Public = e, KAREN S.
Co __ oCommission # GG 20748JS 1) C State of Florida-Notary Public eal)
My Commission xpires = o`; C
June 12, 2022 207484
%u;i����° MY Commission Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION S MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
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