HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Lit
Date: �' `� Permit Number-
RECEIVED
MAY 1•9 2021
Building Permit Application Permitting Department
Planning and Development Services St.Lucie County
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 1/
PERMIT TYPE:
.;e�r e=� »�y'r;'�' '� �"x*yR �' �'��a --
P PE75�f1[t12f1i0U1 (�11 OCATtO � e �3x , ., x .$ ,.4 .�
Address: J'61216 V 6s'74- RL-Vt3 66 A-77 S i Zflcls!:�
PropertyTaxlD#: % Q —S�t� —GtS'�� 0 ()E?' I Lot No. Sr
Site Plan Name: l i'//,—.-z 1,0,412/c' CJAe1 'T q 12LK 3 9- 4-0 '3' Block No. _
Project Name:
G Al L fiL C"d 6 Gc i 5'
i ■{, R y `( x� - ."^'�.. a'� `�s-tr` „�+� `y ,g�`^"„-'!D' - .,,.��tlk5 . s y. •`.},-
- sTRUC'T(c ���n� caly Y El :F''9'`SF- `i.,l* g'd•'P . "t.. 3' tTT,'.-k r (f-Y'� 3•p 4.v j
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Additional work to.be performed under this permit—check all that apply-
-Mechanical —Gas Tank =Gas Piping s''Shutters 'Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
ky:ost of Construction: $�j 3 �. Utilities: —Sewer _Septic Building Height:
,�,}1y+� 3 ."�s •,,,,�a '{'D 4 a " h ,- ice.^ vz+k .r n
gQ�3llCA �.Z r, y `z %s .'8''" .� r "�,� '
Name -Z14FS 1Z 1V J1,6 S Name: Z50_4 Y K A 4-te_45Z AHD
Address ,� "�: 14�7; e,49,C11.4,4 Ve57"" 1:_y0 Company: _VC7�/19A/I(S' S �N�ll Lifi�N f/
City: f�G> e1'�.Z.V C��c ` State: 15r�_ Address:_ '3 'S' rorT LiV
Zip Code: _7?&�9 k, ' Fax: City: State: FZ-
Phone No. 7-2.2 �2/flf Zip Code:_?Jtt 91"2 "Fax:
E-Mail: Phone No-7*72. /,O 0414
Fill in fee simple Title Holder on next page( if different E-Mail �'� l=G/�lr/� AgA4Atf,y eoik
from the Owner listed above) State or County License SaIJ2 01
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.
�. 'YRs's ,.P z3A NkT'Ai*4.1^k
DESIGNER/ENGINEER: _.Not Applicable MORTGAGE COMPANY: ✓Not Applicable4
Name: G r x tp2A=.sr Name:
Address:_ t./-, 10"'*Id',�6- Address:
City: ; ,gAre4 Stater City: State:
Zip: 32 V'W2 Phone 0 y 4d,6 Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: 0"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, l 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 F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LE14DER OR AN ATTORNEY BEFORE RECOki)i JG YOUR NOTICE OF COMMENCEMENT."
Z�:
Sighture of Owner/Lessee/Contractor as Agent for Owner 'Sii6iAure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF �� f✓�l✓ COUNTY OFG. CIr�.
The for oing instrument was acknowledged before me The for oing instrument was acknowledged�efore me
this day of m��J 20011 by this day of M61 20 a. by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification !� Personally Known OR Produced Identification
Type of Identification Type of Identifi'Catio
Produced Produced L� �
(Signature 61 Not (Signatur f•'i�
'' P�b -M f4i 8rFM Fda$EN
tate of Florida-Notary Public
, KAREN S. NIELSEN =' Commission #GG k}5Y4
Commission No. =_° :State of Flo{�allotary public Commissi o��,,{ My rnmr fission Ekbr
ommission # GG 207484 June 12, 2022
My Commission Expires
REVIEWS FRONT ZONING MR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 217119
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