HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �]G
Date: Permit Number: �� " b✓���
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
PERMIT TYPE:
Address: IS7. S,' /u.nv J'7 ,e W ^ CiN, 4 .40 7'—, f,( 10 A9114 -
Property Tax ID #: Lot No.
Site Plan Name: oA P1 2 Block No.
Project Name: )-2- o
Addize
I work to be performed under this permit - check all that apply: •
c nical _Gas Tank _Gas Piping Shutters
EV lectric _ Pv lumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: / Sq. Ft. of First Floor:
Cost of Construction: d c Utilities: —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height:
r,x, , ,
'OWNR�IS� 13 F�
._
w t z ,a t
CO�ITR�CTCIRL
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Name
Name:., ,.q.,rT.°
Address: ' GrOsf a�i`G ;�
Company y��Lur-P, .r%%d� �- o
City: S°" '` ` "' `" '' n State: _
Zip Code: aP q 9 Fax: ��
Phone No. >D-2^
Address. tr
City: .0c e` State:
Zip Code: ` Fax:
Phone No 9s2 - a--
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 4essL-,o-/10,4 •,c
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.
DESIGNER/ENGINEER: _ Not Applica
Name:_
Address:
City: _
Zip:
Phone
ate
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
Citv:
Zip: Phone:_
MORTGAGE COMPANY
Name:
Address:
City:
Zip: Phone
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
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 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
weau yne io a punrD nD AM ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Si ature of 6wnVf Lessee/Contractor as Agent for Owner
Sign ure of contracforFLicense Holder
STATE OF FLORIDA a
�C
STATE OF FLORID
COUNTY OFF � �C)��
COUNTY OF (�
The forgoing instrument was acknowledged before me
The f rgoing instrument was acknowledged before me
w 20.2 / by
, this_ day of �kie e— , 20� by
this day of W"42-
Name of person making statement.
Name of person maki�tatement.
Personally Known e"'� OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
.+ ,� ie•,, . BRENDA ROMERO ZE.A�A
Notary Public - State Of s,orica
o�� °u� .: 8RcN7A ROMERO ZELAYA
Notary ��5ac
Commission N GG 2017' 2
ft comm, Expiresor 19.2022
-State of Florida
o`? Commission - GG 208712
.:
(Signature of Nota PubIiBo&ettbtQA9NNatidea) N ry assr,
(Signature NotaU'd 1rh�o� t+er4 rl` r� 2 ViL
o ar} ssr,
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 21 //19
4v'T,y S�'.Y{T-- _ R'. :�'t''s:�- ', �y` :' {
••i5yy fix' � -
_
�u.. .�`� iS a:.a I�-�' `SYw.�'
.`Y-��SK
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: _
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: 'Phone
Zip: Phone:
FEE SIMPLE TIT.LEMOLDER: —
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 ao the wui R allu 111—ana-11 ao ,..,�����•
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
VIIIFf TU K LCIYUCK IJK wn•w� �vanc. oGrv.�a. ■............
— -- --- --
Ti ature of Own Lessee/Contractor as Agent for Owner
Sign ure of Contra or License Holder
STATE OF FLORIDA��'�� ®
54
STATE OF FLORID
COUNTY OF
COUNTY OF (�ZS"L/
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
C:,: day n-e- 20a l by
this day of , k the 2021 by
this of. -JO
Name of person making statement.
Name of person making statement.
Personally Known "" OR Produced Identification
Personally Known 1 OR Produced Identification
Type of Identification
Type of Identification
Produced db
Produced
:a•.> is•.:. BRENDA ROMERO 11,011
Notary Public - state of s,ofica
; et r Pu SR:r3A ROMERO ZELAYA
= • Not �t 0;ic -State of Florida..
t il[ ± Commission N GG 2911' I
�.:,,_ ,1.2ct2
Q`= Comn•issior - 208712
(Signature of Nota Publiao 1ffim69NtIAidea)NsW', �+ssr
r.
(Signature Notar Id i p t�?, ,: o(ara, ssr.
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
rcev. c/ i/.L7
• I l=