HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S kaJaPermit Number:
RECEIVED
MAY: 21. 2021
BuildingPermit Application Permitting Department
p 5t. Lucie County
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: MaX v
Address: 2-5 TA
Property Tax ID
Site Plan Name:
Project Name:
1014-161FAIV
ve RCe
3L-1` 'b
Lot No. ZZ
Block No.
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:
M)
Sq. Ft. of First Floor: _
Utilities: —Sewer _Septic
Name r % C• ps ` b C'-V 1J
Address:I C.(LA� ->� i (3 LPjt�1�
City: 2 r C!2 Stater L-
Zip Code:Fax:
Phone No�Qrl~ �9 ao
E-Mail:(j.''C-C.f - Oi-qIO Q C�t <\'Pr\ l..
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
City
Zip Code:
Phone No
E-Mail
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.
Building Height:
Fax:
State:
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 Couhty 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 IWIAOYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTP ON HE VOB SITE 13EFORE THE MRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
THY U LEND R;OR AN ATTORNEY BEFORE RECOIf DING YO! IR NOTICE OF COMMENCEMENT."
Signatur r Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SG,'Y COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this �ay of 20A( by this day of
Name of person making statement.
Personally Known OR Produced Identification ✓
Type of Identification
Produced Z> —
(Signature of Notary Public -Stye of Florida) 070
CCaM
Commission No. (Seal) O a?2
Cc!°,3
Z)o0
6
REVIEWS FRONT ZONING . SUPE �.
COUNTER REVIEW REV LL y
DATE VILL
RECEIVED =
DATE
COMPLETED
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
iature of Notary Public -State of Florida-)
mission No. (Seal)
.l I
ANS VEGETATION SEA TURTLE MANGROVE
IEW REVIEW, REVIEW - REVIEW