HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
RECEIVED
Building Permit Application
APR 12 2021
Planning and Development Services
Building and Code Regulation Division P•2rmitting Dsaa ment
St. Lucie C its
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1SS3 Fax: (772)462-1578 Commercial . Residential
PERMIT TYPE:
IN
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Address:
Lot No.
Property Tax ID #:
Block No.
Site Plan Name:
Project Name
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Additional work to be performed under this permit—check all that apply:
'
Mechanical _Gas Tank Shutters .Windows/Doors;_Gas Piping _ —
_Electric —Plumbing j a5 Sprinklers _Generator Roof
Pitch
Sq. Ft
Total Sq. Ft of Construction: ! . of First Floor:
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Cost of Construction: $ ' Utilities: _Sewer _Septic Building Height:
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Name �t/C�c2 �L�/ �/9 Name:
Address: z7� �.�C:oN�/ � I Company
,p Stater- Address-')
City:
li City— . State:
Zip Code: Fax: y
Phone No. �7 Fax:
E-Mail: . R °c� hone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner fisted above) 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: _Not Applicable MORTGAGE COMPANY: _Not Applica ble
Na
me:
Na
me:
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 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 IMPROVEMENT'S TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE .SOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI A STATE OF FLORIDA
COUNTY OF l t ��,( � COUNTY OF
The f r oin ent w instr ,a acknowledged before me The forgoing instrument was acknowledged before me
this'f day of al by this_day of 20_ by
N
Name of person making statement. / Name of person making statement.
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identificatitri— Type of Identification
Produced Produced
i
(Signature of Not (Signature of Notary Public-State of Florida )
'v lypl/// KAR N NIELSEN
2�s" B� ;State of Floqrida-Notary Public (Seal)
Commission No. _ += mmiss §92#)GG 207484 Commission No.
"OFf " My Commission Expires
nnm�` June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS I VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW I REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19