HomeMy WebLinkAboutBuilding Permit ApplicatiionAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 5 a Permit Number: a\03 �L1 •�
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
MAR 0 5 2021
Building Permit Application permitting DaparCmenr
St. Lucie county
Commercial Residential Ir
PERMIT TYPE: �v\�� ��� \ �•\� C
Address: 9 1M 64 S7-w004 Riau Fo2-r PtL:gt- FZ
Property Tax ID #: /�.,��; F ? ^ oo`f tr -oon •r'1 Lot No.(!f_
Site Plan Name: Block No. 3�4r
Project Name:
I
C,a,16
Additional work to be performed under this permit — check all that apply: -
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Wi'ndows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof . Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ -11 too .n-,
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
*r?t'E-',:1=.e�a'$�.s;'�',-•°yr."`�s�..'err--'`:^+t��.',csi,..
Name Oq
Name:
Address: (sA Cr- wcoJ DRI 114(a
Company:
City: �o�'L PfL�tc� State:�1_
Address:
City: y S tate:
Zip Code: SS' I Fax:
e1
Phone No. 7 7 L --w-
Zip Code: ,i -. " Fax:
Phone No
E-Mail:�ir/�y A/�
in (J' ;cc:410 COS.
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
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 Applicab
Name:_
Address:
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
,Not Applicable
State:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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
structure. ture. conflict
lease consult with yourr Hlome Owners Assoc Association
iandrreview bylaws ur deed for any restrts i
ctions o s which may appjyhibit such
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 YOUR PAYING
TWICE FOR IMPROYEMENTS 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 YOU11 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
c A —
1�11
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License H
STATE OF FLORIDA I STATE OF FLORIDA
5
COUNTY OF -C , l.,3c.\-� COUNTY OF
The forgoing instrument
yv as acknowledged before me
this 1.> day of �q1 2004 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced L L
(Signature of Notary PuYic-'State of F rida )
DEANNAGIYEN, dda (Seal)
Nofarq PdbHc'3�
Commission p Cclmm s �a0828 52025
IeA t rnuah National Not ry Assn,
G
COUNTER I REVIEW
DATE
RECEIVED
DATE
COMPLETED
The forgoing instrument was acknowledged before me
this day of , 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
SUPERVIS
REVIEWOR I REVIEW PIANS I VEGETATIREVIEWON I SE EV EWLE I M EVIEWVE