HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO('�MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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RECEIVED
Building Permit Application APR 2,0
1021
Planning and DevelopmentServices 1ttg a n
u` ment
-Building and Code Regulation Division �zr 5t. ou
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-15S3 Fax: (772)462-1578 Commercial Residential X
PERMIT TYPE:
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Address: W f- f� / c r c n F 3 qR 8a a
Property Tax ID #: l— - Lot No.
Site Plan Name:�}rC� �OSSDM 6-6fa�&-5 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: 3. 7 Sq. Ft. of First Floor:
Cost of Construction: $ g DOa Utilities: —Sewer _Septic Building Height:
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Name d l� //UY laG'i 5 _ _ Name: owpne-r
Address: nny X�l ', D w^f I Company:
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City: rf Y!�l^GP la State:-EL J Address:
Zip Code: �R� a, Fax: I City: State:
Phone No. 1 q I- 3 33 Zip Code: Fax:
E-Mail:0SJ Va_f :Qa7 gLo(,CoM Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
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,S00 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applica ble
Name: Name: (Dld h 1&2JIS
Address: Address:
City: State: City: State: _
Zip: Phone Zip: [,-p(�j'j Phone: 900 �L('
FEE SIMPLE TITLE HOLDER: �x- Not Applicable BONDING COMPANY: —yNot 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.
fn 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 NOVICE OF COMMENCEMENT MUST BE RECOR9E>D 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."
Sig ature of Owner/Lessee/ o l.
tractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �C,1� COUNTY OF
The for�oing instr end as acknowledgebefore me The forgoing instrument was acknowledged before me
this,a day of Y 20—A by this_day of 20_ by
7644 P_e l a-c'q�S
Narine of person making sjt4ment. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identific Type of Identification
Produced Produced
1
(Signature of (Signature of Notary Public-State of Florida )
tear r�B
KAREN S. N ELSEN
Commission N 20 ` :State of Florid N(?,Lary Public
Commission 207484 Commission No. (Seal)
-,9jFofF�o My Commission Expires
June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
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COMPLETED
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