HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l�
Date: . Permit Number:
RECEIVE€?
" SAY ��2021
Building Permit Application
Planning and Development Services Farmitting Dtpartmen�
Building and Code Regulation Division St. Lucie county
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE (� \� vJON
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Address:.. l ® ,TL' / K `��`C �ry L/C?
Property Tax ID#: � '—(�� l ��� "��� `— Lot No.�
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Site Plan Name: Block No. C, 3 `
Project Name: >° / P
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Additional work to be performed under this permit—check all that apply:
Mechanical Gas Tank Gas Piping _Shutters _Win'dows/Doors
Electric _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 �, �' Name:j,.
Address:. i Company:
City:;: / G>>'�� State: :Address:
State:
Zip Code: . G :' Fax: City::. . Y' re 19
Phone No; Zip Code. L1 0� Fax:
E-Mail: .Phone No %�
Fill in fee simple Title Holder on next page(if different E-Mail rryL /&zzf-11
from the Owner listed above) State or County License C-0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. a•��o5y
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 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 orpprohibit 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 F!R5T INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/Lessee/Contractor as Agent for Owner _Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF t 1:J e COUNTY OF ]�'• ���
The forgoing instrument was acknowledged before me The f r Ting instrument was acknowledged before me
this day of ��21�� by this day of FYI 200� by
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Name of person making statement. Name of person making statement.
Personal) Known J OR Produced Identification
Personally Known OR Produced Identification Y
Type of Identification Type of Identification
Produced Produced
ax�" JAIX_ (nA &Q1A,,�
(Signature of Notar ublic-State of Florida) (Sig ature of Nota ublic-State of Florida )
Commission No. AUDR �, UMPHREY Commission N .; YN�r -AUD.REYB.HUi(ftiRgY
MY COMMISSION#GG 380817
?' *: MY COMMISSION#GG 360817
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Notary Pu is Un FpF�; So edThrua Public erwrtters
'•••"''e-••••'o?• danvrilers Not
REVIEWS F `°`"' PLANS V ROVE
CO ER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
�ev.2/7/19