HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I t ( Permit Number:
Building Permit Application
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: ,a4 a -
Address: _! ( k'. � as r e' +-lvo Y �P.
Property Tax lD #: - 0 Lot No.
Site Plan Name: S'trcrll�e-Y10O _ chi -"% IP— Block No. �(9
Project Name:
Cc -,r" �C_
Additional work to be performed under this permit -check all that apply:
Mechanical _Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric tom' Plumbing _ Sprinklers _ Generator — Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ \ 2 0 ,y b
Name ' 4 I Y-` tie
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Address: S*Vg t Z ? all- ,
City: verCP State:_L/
Zip Code: 3!AC1& a. Fax: ti
Phone No. `1 i Z r 5-�-9
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company: Vz-e.( tot i) i -lo; r`4
Address: Li L
City: r. rf C e State: t L
Zip Code: 3 Fax:
Phone No 'l i (Pz i -
E-Mail C 1. t Zs
State or County License C, i C_ 41i Z.. C1
It value of construction is 52500 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
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, 1 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 FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN AOORNEY BEFORE RECORDING YOUR�&ICE OF COMMENCEMENT."
Sig ure of Ow er/ Lessee%Contractor as Agent for Owner
si-nature of ontractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ti- c-(T ,
COUNTY OF 4
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thist day of 7vl 20'22� by
thisl5 ` day of i` 20 Zt by
Name of person making statement.
Name of person making statement.
Personally Known R Produced Identification
Personally Known OR Produced Identification
Type of Identification 1,
pe of Identification
SoY
Produced Notary Public State of Florida
rri Lee HiteKern
roduced +►"Y Notary Public State of Florida
y c My Commission GG 367402
cia Expires 08/19/2023
Lee Hite
/� i
' `, Ex Commission 367402
��. ~�cr�� Expires08l19/2023
a
23
', (Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. -) (Seal)
Commission No. �`�l3'Z (Seal)
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