HomeMy WebLinkAboutBuilding permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICAVOIV T iE ACCEPTED
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Zte) 9 Q Permit Number:. .2
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. - Building Permit Application MAR 19 2021
Planning and Development Services Permitting Dapartment
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
462-1578 Commercial Residential
Phone: (772) 462-1S53 Fax: (772)
PERMIT TYPE fa
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Address: -(�3 G I �` (+ 960`
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Property Tax lD#:
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: 07 Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Sept ic Building Height:
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Name Name:
Address: CEO ci S-e G1 f�l Company:
City: O �'� (2r State: Address:
Zip Code: Fax: City: State:
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Phone No. �a. 31a-. O ` Zip Code: Fax:
E-Mail: t) (P tt�q r��h 6C). .0t-1 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 $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: "
Name:
- Not Applicable
I Qy
MORTGAGE COMPANY:
Name: fi
_ Not Applicable
Address:
Address: 120 qw X
City: 17 U.I' / a�
Zip: Sa,5T Phone:_
State: _/�
City: t te:
Zip: .fJ Phone
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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
ructure. Please consth ult w with applicable
Hiome Owners Association to d reviewylaws or an covenants your deed or any restrictions whichrestrict
may apply. obit such
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 IMPROVEMENTS 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 IRECORDING YOUR NOTICE OF COMMENCEMENT."
6fgh-ature of Owner/ Lessee/C
STATE OF FLORID
COUNTY OF
ntract r as Agent for Owner
The foIr� oing instrument was acknowledged before me
this ) day of 1!Pe4 �-'Z0qa a 9by
19 J�Le P T KV
Name of person making statement.
Personally Known
Type of I deRl—filcN,
Produced c1
(Signature of Nota
Commission N
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
OR Produced Identification
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of , 20_ by
Name of person making statement.
Personally Known —'OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
- MY COMMISSION #f GG 330817
1. -'r• T` EXPIRES: March 6, 2023
tiond : Thru Notary Public t ndewtrters z
FROhfTf S�7lPERVISOR PLANS
COUNTER REVIEW REVIEW REVIEW
lam'
ublic- State of Florida )
�G.': •. AUDREY B. MVWYREY
VEGETATION I SEATURTLE I MANGROVE
REVIEW REVIEW REVIEW