HomeMy WebLinkAboutBUILDING PERMIT APPLICATION ALL APPLICABLE INFO MUST-BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater
Permit Number. 7
RECEIVED
Building Permit Application JU. 14 2021
Planning and Development Services St.Lucie County
Building and Code Regulation Division Permitting..
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at'the end of line
PRQPOSED I-M�f'R®�/EMENT L®CATI(3N:
Address: J Z /Y -
Legal Description: b 2 G
Property Tax ID#: /! y " cost m50 " 000 -0 _ Lot No. s�-a
Site Plan Name: 'p9eW i� �c1j / ®c�� �' �,//J Block No. `
Project Name:.
Setbacks Front Back: Right Side: Left Side:
DFTAfLEO DESCR'LPTIOhI ®F VI/®R+tC:
. I!�✓�ove e���� `y ��� ���-ice/— _`/"1 1�.� ;:1�� � G- Via/ '
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CONSTRUCTI +N If Nil FORMATIaN:
Additional work to nrform6d un er t is permit-check all apply:
14 1HVAC Gas4ank t �Gas'Pi 'ing _Shutters Q .indows/Doors
Electric 0 Plumbing, Sprinklers Generator i_Roof Roof pitch
Total Sq. Ft of Construction: .9�r��� ,S . Ft.of First�floor: ��(��
Cost'of Construction:$ �� Utilities: Sewer Septic Building Height:
®WN'�ER/LE�S�EE: CO�N�R/1C�T�CJR:
.Name ' B �� Name: p;. <:L .. ✓'
Address: ; .Le.: �v� ., Company a", 1
city: f%�.t' LtrG� state: li Address: lr
Zip Code:� _ _. Fax City:;, Stater
:.:
Phone No. ,�7� `!✓2 Zip Code: :3 1,9 cf` Fax:Z?Z-t /'40-92
E-Mail: 72- �rs �T�, Phone No.172 a,0) —
Fill in The simple Title Holder on next page(if different E-Mail: ,!;11/'2� D✓ 1e___f 614-511
from the Owner listed above) State or County License: elf e 00 4'70 6
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
WHIMI.EI\/UE RM/ TION:,
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:
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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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.
A4�/i -
S
Signature of Owner/Lessee/Contractor as Agent for.Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,_�. W 11c, COUNTY OF
The oing instr en was acknowledged efore me The forgoing instru ent was acknowledged before me
this day of 2 '&t by this day of 20a by
+L - 6) kPie-1 6m
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Pr du ed Identification
Type of Identification Produced Type of Identification Produced L IJQ,n!
IELSEN
Commission No. ,��;JP�B., KARE,�`1 N `� +i•un� KARE_N S. NIEL
;_ �, rate of FP a-Notary Public Commiss' rla �. � ��
=_, *= Commission.# GG 207484 a �� a-Notary u c
ac ammission Expires Commission # GG 207484
'''��iliii\" June 12, 202Z ;i dill June 12, 202P
Revised 07/15/2
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW. REVIEW
DATE
COMPLETE
INITIALS