HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I �-
I-,-/1
Date: c �? 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
PERMIT TYPE:
3
Address:
Property Tax ID #:
Site Plan Name: _
Project Name: _
Lot No.
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:
Cost of Construction: $
Sq. Ft. of First Floor: —
Utilities: —Sewer —Septic
Name
Address:
City: State -
Zip Code: // Fax:
Phone
E-Mail: VW, c
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 TMTTGAGE COMPANY:, _ Not Applicable
•
Name:
Ad d re:
City: _
Zip: _
Phone
Address:
State: City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name" '
Address:
rite•
Zip: Phone:_
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip; Phone:
i, A try+n1intinn nr indirntPd.
OWNER/ CONTRACTOR AFFIDVIT: Application is heresy mace to ouiaui a P-,
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.
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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 .HOB SITE BEFORE THE MRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDRAG" yOL R NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 1. A
STATE OF FLORIDA
COUNTY OF
The fo oing instrument was acknowledged before me The forgoing instrument was acknowle2gged before me
this day of Mez 20Q by this day of
\�An.Kj
Name of person making statemen y
Personally Known OR Produced Identification
Type of Identificatiq�a!'
Produced' L
(Signature of Notary Public- State of Florida)
4PRy p��� KAREN �-Af�II�ELSEN
Commission No. of Flor a--iV tary Publi
=+ Commission # GG 207484
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
I June 12, 2 22
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REVIEWS OR PLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW
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DATE
COMPLETED
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SEATURTLE MANGROVE
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