HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE NFO WST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: @�Oy'�aC'1�
RECEIVED
Building Permit Application APR - 7 2021
Planning and Development Services
Building and Code Regulation Division 'ermitLuc DCc u Yty rtm/
2300 Virginia Avenue, Fort Pierce FL 34982 Lucie Co
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
IS
HM
# :
Addres . TM0
Property Tax ID #: a ���� (3da -0(�a Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
ectric _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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Name �/ C.�yr Name:
Address: b r` ��r I Company_::.
City: `�E�t'' , State Address
Zip Cod Fax: I:City: State:
Phone No � `' -Zip Coder Fax:
E-Mail: hone No
Fill in fee si ple Title Hoider on next page ( if different E-Mail
from the Owner listed above) I 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.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:.` Not Applica ble
Name: Name.
ss:Addre 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 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.YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
"I W-1
Signature of Owner/Lesse ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S�-, l.�t �"� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this') day of ZOa.\ by this,day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identific tion Type of Identification
Produced V L Produced
(Signature of Notary blic-State of Florida OEAsyNA yS judd�
nature of Notary Public-State of FloridaG,v-
State of ikoCommission No. H d�3 yD°°�;�{S�et�rlpubkk� �HHOS635mission No. Seal Commissioc1LgMYComm,Expires Jan 2fS,
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REVIEWS FRONT SUPERVISOR PLANS I VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW I REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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