HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:in - l • '�L1 V e Permit Number: 0
~'F RECEIVED
s-
Building Permit Application JUN 0 4 2021
Planning and Development Services St. Lucie County
Building and Code Regulation Division Permlalfig
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
PROPOSED iMPROUE , DMI MANT11QN:
Rress': %�o ��SS Roa�� ro�� ��erc�� t`�. 3 y58z
[�
P operty T ztlD-#" � 140 � " 501 (YL 230 - I Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DE=-SCRIPTION t6 O'R
U 1 0� x Zy \ skoSrLg t J�n�c�v e�;�r Sties aov 521.k�.
S�G.C.\ \,j;1\ `\Vt, N&ksa On Cann, .ate j\oaaej fi 0,,,CN^G«-e�
CONSTRUCTItaN INFORMATION:
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
T` otal SgFofaC�~ onstru"ct �� Sir Sq. Ft. of First Floor:
,Costlo Cons r,�uction Z° J'�`� Utilities: _ Sewer _ Septic Building Height: '
Q- NER/LESSEE:
CONTRACTOR:
Name:
e PA\kP l`A1 Jcc.iu
N[Ad
ss: 610 2�55 (2—A
Company:
)✓o r } P'ercc. State: FI'
Address:
City: State:
ode: 3 i9$Z Fax:
e No. 7 is - S��- 68 f1
Zip Code: Fax:
il: de 11� u 6 o e p /'to t,, Co /K-
Phone No
fee simple Title Holder on next page ( if different
E-Mail
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.
1,.
UPP MENTA CO STIR IO WKENN�
DESIGNER/ENGINEER:. — Not Applicable
MORTGAGE COMPANY: — Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING., CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Stgnatue of=0w:ner/'ssee/Contractor as Agent for Owner
�,� -
Signature of .Contractor/License Holder
STATE OF FLORIDA.
COUNTY OF �j�-�1(mj �C�
STATE OF FLORIDA
COUNTY OF
The fo oing instro ent was acknowledgedy� efore me
day '�
The forgoing instrument was acknowledged before me
this of 20�1 by
this day of , 20_ by
ffiicf\0.191 V. ucc_k U
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identif' on
1- 'b L
Type of Identification
Produced
Produced
�-O
AA
(Signature of Not
(Signature of Notary Public- State of Florida )
Commission No.
`�S YIV�� KAREN S. NIELSEN
;_° ��QState of Flor(g@ tary Public
*= #
.
Commission No. (Seal)
ommission a 207484
My Commission Expires
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