HomeMy WebLinkAboutBuilding Permit Application rrAI,APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 .Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
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Address: S 5_6 y.. . fo)tT
Property Tax ID#: 3q Da,-` g ID ` 003- ' DDI?1 7 Lot No. /vZ_
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: Sq. Ft. of First Floor:
Cost of Construction: $ 'Sd0 , °O Utilities: —Sewer —Septic Building Height:Na me pa y& Name
Address: 5500 SSIfR DrL A9 iC'o npanyrivtLr x;";
City: 5)RAr G 1 ra'ab State:
Zip Code:Ty 9 0 Fax: State:
Phone No. 61e (, �� � .777Dy Zip Code: Fax:
E-Mail: ]l'jROwN oZOhGwvPrl l� Ci)rn Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed abo e) Cc 0Y ��L State or County License
if value of construction is$25 0 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or m re,a RECORDED Notice o ommencement is required.
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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:
j 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.
I
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 IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST DE RECORDED AND
POSTED ON THE .BOO SITE !BEFORE THE FIRST INSPECTION. IF YOU .INTEND TO OBTAIN FINANCING, CONSULT
*-tH YOUR iLEN-DER OR AI ATTORNEY.BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
ignat of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF k ��1f3�t% COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�day of �!"��� 20 2A by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known x OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-Stat2otF} rida )NICHELLEHSANTOPA (Signature of Notary Public-.State*of Florida )
�' Commission#GG ISM
Commission No. # :SealiWresApn128,2022 Commission No. (Seal)
'4oEa�P eormwnwesnamn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION.' SEA TURTLE-' MANGROVE
COUNTER REVIEW REVIEW REVIEW - REVIEW --`REVIEW• REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
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 paying twice°for
improvements to your property. A Notice-of Commencement must be recorded in the public-records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
ignature ner/L se ontractor gent for owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA -
COUNTY OF- ��� (� CA.�_ COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
ih i�s_n day of Yti 2020 by this day of 12020 by
Name of person maN�g statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced. N, 0 C "Produced
(Signature of Notary Publi LLEN VAUGHNk1griature of Notary Public-State of Florida)
`1p,PY PV6
;_� <<-;state of Florida-Notary Pu lic
Commission No. _. ._ ( d$ission #GG 2700 9C mission No. (Seal)
My Commission Expire
October 22, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20