HomeMy WebLinkAboutBuilding Permit Application 3 SCi - Lu _(o
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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)462-1578 Commercial Residential v
PERMIT TYPE:
Address: f 5 • ict.L-e0.eL, SJR1TW C ZZIoi,
Property Tax ID#: NZ(, S6( C.�D S �X?h' 3 Lot No.
Site Plan Name: Block No.
Project Name:
e... ....... .... . .:.. ,ri.77 C}l flisal RMATiON:
I
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
/
Electric v Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 1 3 Sb, CC Utilities: _Sewer _Septic Building Height:
Name -i"t^ch 9ry Name:G-Lr4 i-<<r. •-S
Address: 32 ZT 5- LG 4e-y.�e.> L ' r (� Z 2t0(o Company: Q� -t °to rr-to:r`�
City: i7 - P.ic-L .. State: F4- Address: u l S S . 0 S_ b ,n I
Zip Code: 3 Lka Lt.�i Fax: /Ul W City: State: t C
Phone No. -V-) Z -135 c ` 16Y LP Zip Code: 3�111 9 J, Fax: N A
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License C �C i Z a 3 l
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU NTEND TO OBTAIN FINANCING, CONSULT
WITH YOVR LENDER OR AN WORNEY BEFORE RECORDING YOU ONCE OF COMMENCEMENT."
Sig u w e re of Or/Lessee/Contractor as Agent for Owner ' nature o
f ontractor/Licensee Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF JQ_"c�r ."
The forgoing instrument was acknowledged before me The forpoing instrument was acknowledged before me
this \Pa Bay of Or 20 by this�t day of CS 201 by
s � - t'��r-- ` 5
Name of personrfiaking
�stattement. Name of person making statement.
Personally Known L' OR Produced Identification Personally Known L_1� OR Produced Identification
Type of Identification Type of Identification
Produced duced Ste'
otary Public State o/Florida fi�
p Kerri Lee Hite a C_
MY Commission GG 367402 � 419020'
q,R Expires 08/tp/2023 41. 1C.� . OAV%0%0
(Signature of Notary Public-State o o i a ignature of Notary Public-State of Florida)
Commission No. 3� 4_�OZ- (Seal) Commission No. 3 b 311 U L (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE 'ON Note Public State o/Flori
da
Ker
COMPLETED n ee Hite
ev. e�R Expiros,Z1 /2023 387402