HomeMy WebLinkAboutBUILDING PERMIT APPLICATION I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,�c• �' � � Permit Number:
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RECEIVED
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Building Permit Applica#on DEC 21 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 Reside Itial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: :
Address: � �.� '.ir�
Legal Description:
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Property Tax ID#: � ,,11 SbV- ` -52 -ZXDO I �- C7�2 Lot No.
Site Plan Name: CC: - c Block No.
Project Name:—re- - r- x")-P
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�e�����. kn LA DI
CONSTRUCTION INFORMATION: - A
Additional work to e e orme under this permit-check a apply:
11HVAC Ei Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbin _ ator Roof -� Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor: d.
Cost of Construction:$ Utilities: _Sewer F_Septic Building Height:
OWNER/LESSEE: CONTRACTOR
Name 6 Name:
Address: pl '�5 T c �t vC'v l Company: v' h
City: State: CiI Address:
Zip Code: �34C60` Fax: City: Ft i`��� State:
Phone No. V"`' �7 Ti i IZip Code: ��Z S'� Fax:
E-Mail: d l 'c°� 1 hone No. -7 -R Y 1
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Fill in fee simple Title Holder on next page(i ifferent E-Mail R
from the Owner listed above) State or Co y License: (;�.C('SL�, C ?►�l
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: i 1I
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: I. — State:
Zip: on Zip: Phon
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: h (e: 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.
Inconsideration 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 Noti a of Commencement. .
—` s
Si ture of her/Lessee ontracto as Agent for Owner Si of Con ctor/Li se H er
STATE OF FLORIDA STATE OF��lel� COUNTY OF
The
COUNTY OF G-
The forgoing instrument as acknowledged before me The f rgoing instrument was acknowledged before me
this day of '� 7 20�by this day of ,20 ZI by
iRAY V t," 1) ."cR 4 9,6 eaIV
(Name of acknowl gi ) ! ( me of person ing)'I
Zersonal
atu 1�;tl
tate of Florida) (S gnature f Notary bl -S e,i f Florida Produced Identification Perso n OR Produced Identification
Type of Identification Produced Type of Identification Produced
0<►3�;P& DEB0 COURTNEY ot!g:P�B DEBOR Q�p
Commission No. •' • o a Commission No. URTNEy
* * CE #HH 135416 * , Commissbn#HH 135416
Expires June 15,2025 Expires June 15 20
No"S&Vkw Op Ft° ftWedThmBu*tNoluySMYbBS
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
COMPLETE
INITIALS
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