HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:�\Q I Al.
Date: q- >- jl
s.
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578
PERMIT TYPE:
RECEIVED
building Permit Application
at. IM110 county
Permltting
Residential
Commercial
JUL 01 2021
Address: S {
Lot No.
Property Tax ID #: 3
Block No.
Site Plan Name:
Drniart' NamP' /'l%irsA i� a"'a'.A / y 020
Additional work to be performed under this permit - check all that apply:
_Mechanical _Gas Tank Shutters _Gas Piping _ —Windows/Door- s
Electric _ Plumbing _Sprinklers
Generator ' "'Roof Pitch
Total Sq. Ft of Construction: (pt� .i�1' Sq. Ft. of First Floor: _
$ , ��� Utilities:
Cost of Construction: _Sewer Septic
Name e ti^moo abet—✓]r
Name:
Address:Ul_CT�vP�S �.+��`
Company:
City: �{Z�P�Ii lQ Stater— I
Address:
Zip Code: SLtq'51 Fax:
City:
Phone No. -172." 5IA 8002<
Zip Code:
E-Mail:•z�r ��?
'�"�
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
I 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.
Building Height: —
Fax:
State:
DESIGNER/ENGINEER: —Not Applicable
Name:
Address: '
City: State:
zip: :Phone
FEE'SIjVIPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE, COMPANY:
Name:
Address:
City:
Zip: Phone:.
BONDING COMPANY:
Name:
Address:
r'ity•
Zip: Phone:
Not Applica ble
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
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict y rpppro/hibit such
structure. Please consult with your Home Owners As'sbciation'and review your deed1or.any restrictions which ma •a I. .
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 �ooms,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 R'AN ATTORNEY BEFORE ;RECORDING YOUR NOTICE OF COMMENCEMENT."
0 .1
.. n.
rOwner I Signature of Contractor/License Holder
STATE OF FLORIDA,�- 0 i r /0
COUNTY OF
LJI li(��ij/��
The for oing instrument was acknowledged before me
this day v n_ 20cr by
CilYl3VLJ kt.CJ
Name of person making
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of , 20_ by
Name of person making statement.
Personally Known OR Produced,ldentification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced 0 Produced
//
(Signature of Notary Pu ic- State of FIB YPGm, nature of Nota11 ry Public- State of Florida )
_♦ .St ELLEN
c to of Fior; aAUG ��i Seal
Commission N , O"Loe�;� Mmmission �o�� rubiic ( )
yoctmmis ion E27007g
REVIEWS FRNT CO ON ER I ZONING REVIEW I SUPERVISOR REVIEW
DATE
RECEIVED
DATE
COMPLETED
C��f1fiL';•
VEGETATION SEATURTLE I MANGROVE
IEW I REVIEW REVIEW REVIEW