HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE iNFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �Q •�5• '� Permit Number:
RECEIVED
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L Building Permit Application St.Lucie County
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Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
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Address: ' 9 tV, 41 A 14A;f-
Property Tax ID#: \A\\k- loo-L oe ooC Lot No.
Site Plan Name: �tQe.�.L[4 �an�. • a Block No.
Project Name:
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CONSTR�UCTIOI��tNFORM`AT(C� ,, }; �rr� �
..'s 5 h.:. ,_v..;.:.,..:.a6e h.Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq_Ft_of First Floor_
Cost of Construction:$ 'OOD• o O Utilities: _Sewer _Septic Building Height:
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Name Fto.,nkC Qa.nZar: no Name: L ► F
Address: Mq%A ck N th A it i 7 2. Company: v\k Cg, 6001 yk1,( C.On Lk:avt Ln r.
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City: F It Q:Q.c(Q State:-�A Address:Z o\o% 9 *,Saw S+ J
Zip Code:3 K a u Fax: City: 5 k,,)o,A k State: I% 1
Phone No_�3 IL i 6 o 4 - 69 2 a Zip Code:'�y w a►'l Fax:
E-Mail: �ranlL�anzo.v Jw►a�� • cry Phone No'I I'L- y%b - o % q,2
Fill in fee simple Title Hofer on next page(if different E-Mail a VV4 � O-L • G r�
from the Owner listed above) State or County License L l&G %!%1 7 2 3 $
If value of construction is 25M or more,a RECORDED Notice of Commencement is required.
If value of HAVC 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 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 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 paying twice for
improvements to your property.A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection.If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
S' ftre o ne se ractor s Agent for Owner =OF
tor/Lic se o er
STAT F FL A
COUNTY OF )C,(?, COUNTY OF
Swo/mlo(or affirmed)and subscribed before me of Sworryto(or affirmed)and subscribed before me of
V'§hys" 1 Presence or Online Notarization Z by i al Presence or Online Notarization
this of�)r)e 2021 by this of 3j 1 - 202Q by
Name of pe on making statement. Name of p rson making statement. /
Personally Known OR Produced Identification_� Personally Known OR Produced Identification y
Type of identification Type of Identification �1
Produced 10S $'3� Produced
(Signature of Notary Public-State of Flqtd ) (Signature of Notary Public-State of Flori a)
Commission No. l� Rebekah Hoy Commission Flo.� � 415
Reber Hoy
e NOTARY PUBLi NOTARY pUBL1
� Y`'STATE OF FLO o STATE OF FL
y omm#GG2946 0 W Comrrw GG29461
REVIEWS FRONT ZONIRi �� 2gPLANS VEGETATION SEATU� 9�� �j20 3
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
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COMPLETED
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