HomeMy WebLinkAboutBUILDING PERMIT APPLICATION ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
_..`_. ..._._....__.
Building Permit Application DEC 0 7 2021
Planning and Development Services St.Lucie County
Building and Code Regulation Division Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential !�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: leo6Qp- % �c:�i a —,a-
Legal Description: / 1922,0 4 10T
Property Tax ID#: ��`�_ �= 401J Lot No.
Site Plan Name: Block No. !�
Project Name:
Setbacks Front Back: Right Side: Left Side:
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r CQNSTRUCl"lON )NiFORMATION �; � �� #'�� �.
Additional work to e e orme un er t is permit—check a apply: "
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❑HVAC Ei Gas Tank []Gas Piping ILI_Shutters Windows/Doors
❑Electric ❑Plumbing ❑Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer❑Septic Building Height:
¢ # } ° r`;;_s��Y isa+e ,Ar-K $ L W .;m�. +-� xxi . r +`a' Ir a xy✓ Moz�..
OUIl�11fR/LESSE� �, i zCONT) ACTOR � s,
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Name G',P�x� 1-21"_ /mil Name:
Address: 1 ,6 00 Company:
City: ,4� /10/cvr--P State: Address:
Zip Code: 3�151F� Fax: City: State:
Phone No. 7�1�—A0%—< 3111 / Zip Code: Fax:
E-Mail: aGa Phone No.
Fill in fee simple itle 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.
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DESIGNER/ENGINEERi:,` " ` -_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:
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 jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
79"i a re caner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged-before me The forgoing instrument was acknowledged before me
this_day of 20 14 by this day of 2014 by
1
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. -(Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS