HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 310 a1 . ),tq ".-'ra Ps
Legal Description: SiS CC QZ 6 r1 Fa Nc
Property Tax ID q: N31-gO7 - OOLiQ-QCK>-G Lot No. '8ea
Site Plan Name: Block No.
Project Name: _
Setbacks Front Back: flight Side'Left
VTAILEDsDESCRIPTION OF -WORK:
kNSifWi .,ION_IN �' lit • _ _
rtiona worcto e e orme un ert is permit —c ectca appy: -
ll❑�IIHVAC Gas Tank ❑Gas Piping _Shutters windows/Doors
L_ (Electric OPlumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: 5qFt. of First Floloci
Cost of Construction: $ Vu i. R % Utilities: Li Sewer Ll Septic Building Height:
Name(TIAC A-kA Le.w'
Name:.ictt:�-rrr-
Address: 3 KN l i0 R� fi A
� <z h o-
Compani
City:}} Q,F,rc.e- State: Fj
Address: 124Ln( -]qTH OT A2
Zip Code:,344 4 Cu Fax:
City: L.v. `i lvti O J-� Statr._F_`
Phone No.?-)J-At 7'%33a
Zip Code:33412-- Fax: 51,1.a55% C/oS
E-Mail:
Phone No. SLd - FSS . 4 0 a
Fill in fee simple Title Holder on next page (if different
E-Mail: t F (.. tom
State or County License: d
from the Owner listed above)
B value of constnutlon is S1So0 or more, a RECORDED Notice of Commencement is required.
DESIGNE ENGINEER: x 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 ermit holder to build the subject structure
is in with any applicable Homeowners Association rules, bylaws or an covenants that may restrict or prohibit such
which conflict
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."
I&n I
Signature of crivner/ LesseelMontractor as Agent for Owner Signature of Contra or 'tense Holder
STATE OF FLr1i)A STATE OF FLORIDA
COUNTYOF 'YPI 9,e0 c-1. COUNTYOFP--a
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this L3 dayof CiP� .20� by this (.S day of iicce r L„ a .2021 by
("(r\c--ki11 i,A - "ES D. DAV*
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification _ Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signs re of Notary Public- Skate of fIAN dEIAYC„"IG (Signs re of N tary Pu c-State of Florida)
S6 °au ANGELAYOUNG
Commission No, Commission No s Comm( 11-G%8854
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DATE
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DATE
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