HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CON) TED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: l// (/(/)"
Building Permit Application RECEIVED
Planning and Development Services Building and Code Regulation Division JUG 2021
2300 Virginia Avenue, Fort Pierce FL 34982 Perris in artment
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentialst. Wide County
. .
MTam •4•.
Address: J7aD, Pih� L t�tz�L �°� ��'`t�� '- 34ci4�
Property Tax ID #: ).`7j 761 Q0oZ7 00d15, Lot No. __ q.
Site Plan Name: 1k®SS &-0-f'qT Block No. 25
Project Name: �ps5 sra9�
11) X 30 `6" cn-ne 51dl& C�i l.reve-
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: Sq. Ft. of First Floor: )�o�
Cost of Construction: $ q 56 D Utilities: —Sewer _Septic Building Height:
ki3
"gg gag MN
�+�w
'�
S�
f
.`OW .r W •
Name ft fr A RoS�
Name: f)t5rru,nceSGo
Address: Lp hJ- 46YA V- P014 TfaiL ;T.
—Mj
Company: IJ r �7�.n v►eeSCa CD �Sd-rc� �+'` �✓«
City: ET Q `t,f 9 A State: � c ''
Zip Code: 3'fg�15- Fax:
Phone No. 1, q Sap c/37 4
Address Y'a 40 I a 4eS6;n.e P; y c R-41 }t
City: I-,9L Stater`
Zip Code: 3r -q b�- Fax: 771 LIK 7X73
Phone: No 7tL 2-01 7747
E-Mail:
Fill in fee simple Title Holder on next page ( if different "
t�
from the Owner listed above)
E•-Mail . i rencv�S-i' inc �e 40L• Ca""
State :or County License Rg a40 3ba
If value of construction is $2500 or more, a RECORDED Notice of'Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: - _.. _
Name: (Aci -11- 6aLdlwin
Not Applicable
? F
Address: I o195$ S - Cwn1:3 2P
2� 1
City: S *kg r Ka
State:
Zip: '�20(41 Phone
FEE SIMPLE TITLE HOLDER: —
Not Applicable
>u a
Name._
Address:
City:_
Zip:
Phone:
MORTGAGE COMPANY
Name: N ►'E
Address:
City:
Zip: Phone
BONDING COMPANY:
Name: M
Address:
City:
Zip: Phone:.
Not Applicable
State:
Not Applicable
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
structurin e. Please consult w with yoiurr Home Owners Association Association
rules, bylaws
your deed for any covenants
that
o s which may arict orpply. 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR * ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
.. —T .
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/Li nse Ho er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 54- L& CJ -c COUNTY OF
The forgoing instrument was acknowledged before me
this I-g' day of 'C? %2c- 20_Z by
Name of person making statement.
Personally Known `- OR Produced Identification
Type of Identification
Produced
Signs ure of tary Public -State of Florida ) - " Fl�
Commission No. (Seal)
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
t!19'
COMPLETED
The forgoing instrument was acknowledged before me
this day of , 20_ by
Name of person making statement.
Personally Known .OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
PLANS
REVIEW I VEGETATIREVIEW ON I SEATURTEV EWLE I M EVIEWVE