HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE NF%;UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: G Permit Number:
��• �"v Q
S, (?, RECEIVED
Building Permit Application MAY 2 0-,2021
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
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
Gds ��s uCttc
Permitting Department
St. Lucie Countv
Residential
Lot No.
Block No.
Additional workto;be performed under this permit -check all that apply:
_✓Mechanical — Gas Tank — Gas Piping —Shutters /Windows/Doors
V/Electric Plumbing
Generator _ Roof Pitch
_ rn�g — Sprinklers —
Total Sq. Ft of Construction: 2 l Sq. Ft. of First Floor:
Cost of Construction: 000 - utilities: —Sewer _Septic Building Height:
Name.1 hrl( doeJR
'
Address: ' ®✓r ei°/' 4 rtil'e
City: V der State: Ph
Zip Code: Fax: /�
Phone No. 779-- 201 2710
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: l Nfi 61"M7O
Company: Fr6 yule /f
Address: Zas f Aa7 Or S4
City: X�o . 6 State:-,El(
Zip Code: 32-9i�Q- Fax:
Phone No 2 --jffe�,:7-
E-Mail
L-Ois %� rem e / • �o�
State or County License aW lR31'M
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: 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
structure. Please consult withpyoiurHlome Owners Association Association
reviebylaws ur deed focovenants
any estrthat
t ons whirestrict
h 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 .DOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECOIRDiNG YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of C ntractor/License Holder
STATE OF FLORIDA/UA _ STATE OF FLORIDA
�}C,IC�
COUNTY OF . _k )0 I �_ _ COUNTY OF
The for oing instru nt was acknowledged before me The forgoing instrument was acknowledged before me
this o`� ay of 200-� by this day of �{Q1�) 20Q by
T!a L_�uIC rzB W1 TO
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of (dent` ion T Type of Identif' ion
Produced l� V _ Produced PC —�—�
(Signature of LSEN
KAR
(Signature of No
ry�Rw bJjc- a A i . I IELSEN
''P `A' -
,a° `�c State of Florid�CNo
State of Florida Notary Public
N "= #(5(r81h07484
Commission No.
- �j ry Public
=' 'c Commission VP�fi� 207484
Commission .'2 fission
My Commission Expires
%',oFFtoQ;' My Commission Expires
June 12
0;June 12, 2022
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