HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,fr Zl Permit Number: TWA-66S I
RECEIVED
Building Permit Application
APR 1. 9 2021
Planning and Development Services rarmittkng Department
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772) 462-1S53 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
Address: (0 6 oz' � _ .1��t/t.1 r �i e2E�zy
Property Tax ID #: �"�4�"' �o�, "' �3`�"'J-ddV-� 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
_Electric _Plumbing _Sprinklers -Generator _-Roof Pitch
Total Sq. Ft of Construction:) 1� Sq. Ft. of First Floor:
Cost of Construction: $ 3 -utilities: _Sewer _Septic Building Height:
a .>� -3--�.-^
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Name �iobP� l n� 6C,kee, Name:
Address: (0to9 4 ,QKe&d1f 6)1/01 Company:
City: 1^'o@,I' i'�e1zcc State: Address:
Zip Code: yf!%( Fax: City: State:
Phone No. = s Zs 1 1 14,7 Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
j from the Owner listed 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 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 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 .IOU 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 FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forg Ping instrumen was acknowledged before me The forgoing instrument was acknowledged before me
this ay of 20A9 by this_day of 20_ by
Name of person making statement. e of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification ,((��/ Type of Identification
Produced p✓�/ Produced
(�J V
(Signature of Notary Public-Stafle of Florida) (Signature of Notary Public-State of Florida )
Commission ` PUBS FII EN VkWaG)HN Commission No. (Seal)
;20 State of Florida-Notary Public
=* Commission # GG 270079
9r Q Z y ommission pares
�ii f OF FAO
REVIEWS ��" - ISORFRPEV
LANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW IEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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