HomeMy WebLinkAboutBUILDING PERMIT APPLICATION i
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLI ION TO BE ACCEPTED Date: Permit Number: G i
SEP 03 2021
le County
St'P rmittin9
i R
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)462-1S78 Commercial Residential y
PERMITTYPE:
Address: Sgv S 7Gif'w t!p4_ b lam' zz CI-e F 2✓G4 3 Y q ?2
Property Tax ID#: Lot No. ' _3 f--2-°4
Site Plan Name: I Block No. U
Project Name:
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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_Sa Ft of Construction,; Sq. Ft. of First Floor:
Cost of Construction `$ "< '1Y, Q- Utilities Sewer.,,: Septic;.; Building Height:
Name ;R; $L GLJ v '1MAAA
Name: Y v11G _/!"r i
Address: 6/ �Y kllme'e'� invef Company: J� �� ,z �7� G ►�
City: F P!cry-4f State: Address )
Zip Code:_�Yy 2— Fax: City: //, �C�^ State:_PJ_1
Phone No.772— 332-,,,Z.3-5' Zip Code: -3Vf'4 S Fax:
E-Mail: Phone No 77� Z(&
Fill in fee simple Title Holder on next page( if different E-Mailer 00• Jugs Cal
from the Owner listed above) State or County License �� /S
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: _ 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE .IOU SITE BEFORE TIME FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH Y UR LENDER AN ATTORNEY BEFORE RECORDING YOU OTICE OF COMMENCEMENT."
Sign re o ner esse ontractor as Agent for Owner Signa Corr /License Holder
STATE FLORID STA F FL
COUNTY OF �. • �-1A G e- COUNTY OF S�+ k Li(A
The f r ing instrume t was acknowledged before me The forgoing instrument wa acknowledge before me
this_day of 20" by this T� L d S ay of 20�� by
es SNO
Name of person malZing statement. Name of person making statement.
Personally Known Personally Known
Type of Identification ll,=1g Idag sa116a uolssiwwo0 IN Type of Identification. TRICIA AtVN ATKINS
Produced E In JJ#uolsslulwo0 Produced State of Florida-Notary Public
ollgnd/UeloN-eplJOH 10 OMIS ommission#GG'141430
SNpI,Ld NNb� dlaibl My Commission Expires Sept.6,2021
(Signature of Notary 1Public-State of Florida ) (Signature of Notary Public-State of Florida )
Commission No. Ll\y�� g� �,(Seal) Commission No. I -\ (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19