HomeMy WebLinkAboutBUILDING PERMIT APPLICATION Ali-APPLICABLE INF U TEE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: cI
RECEIVED
Building Permit Application AUG 3 0 2021
Planning and Development Services St.Lucie Coun
Building and Code Regulation Division Permittin
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
Address: 2 OV'2 �/1 J
Property Tax ID#: 3 J 2) ko- — na i oc�3 — `o Lot No.
Site Plan Name: Block No.
Project Name:
R-g
�-'�.p §='�*, { - � e '�'�...._ �^�..�_;�••!.` �-�`�-��.� � - Cr -+;r� a� '?,� - - �.=ii�a.�� -5l
.�t1 %, ,•�Sy+€ Ksr�. � ,y�
C �111V���F � i �14Y S - m p is 1 e t
MEN _ ...
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters endows/Doors
Electric _Plumbing _Sprinklers _Generator oof : 1ZPitch
Total Sq. Ft of Construction: 3 6 0 Sq. Ft. of First Floor:
Cost of Construction: $ _��� - �.J Utilities: —Sewer _Septic Building Height:
6' ° sue;.��rsKva �w*s� �.J-r'S'�' 1x `:
�8! � .G�
.-ems r ...u.-,.. .,+^....,-.,...,..:.. -
Name ( 2r Name: V-2
Address: a23 c7 oi-S� 1 eC� Company:
City: d-y— Stater Address: 3 5-2
Zip Code: Fax: City: State:
Phone No. Zip Code: C7 Fax:
E-Mail: Phone No 2— ?✓3�_ ���
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) 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.
I� 240 ,_6 a
Y; "
s< �ne %
�1 '+tak2,.��;'�i€fL��".++3r.:"e`�'5' t�.E�'��.ac,�� n:��rsiT��',,a�.+6 �fif.3^�_.._.-."4.�i;� .. .c-•.�..r.z_ t�y.sn,s.3,.z...-",3ss� �_ ,.-`-.
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 CO CEMENT AY RESULT IN YOUR PAYONG
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOT������ORDED RECORDED AND
POSTED ON MP .SOB SOYEENT BEFORE Y THE ROPE INSPECRlCINO CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECO — XT:
Signature of Owner/Lessee/Contractor as Agent for Owner Sig ature ontractor/License Hol r
STATE OF FLORIDA STATE OF FLORIDA
�.
COUNTY OF COUNTY OF c'r in
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_ by this aQ:�day of Akcitcs t- ,20gLL by
Name of person making statement. Name of person making s tement.
Personally Known OR Produced Identification Personally Known OR Produced Identifi tion
Type of Identification Type of Identification X_ d g
Produced Produced a o z
� o3mc
my Ta
O y N
(Signature of Notary Public-State of Florida) (Si nature of Notary Public-State of Florida ) o02.
Commission No. (Seal) Commission No. 1+1+-00C, a (Seal) d
`REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.