HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONBuilding Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 0
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: i�jlc=Ad►nc'
PROPOSED IMPROVEMENT LOCATION:
Address: 33-5- /,/-iW 1 611161, 05eyi Zfac
Property Tax ID #: 4/sz;T'�1 -,5-0 /- 6-5-21 - 600 - Ct Lot No.
Site Plan Name: Block No.
Project Name:
I DETAILED DESCRIPTION OF WORK: I
all::-
CONSTRUCTION INFORMATION:
N
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ _2- 49� ''
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: -Sewer _Septic Building Height: f�
OWNER/LESSEE:
CONTRACTOR:
Name
Name: &06LA te-2a is i-
Address:,J A&)o'%S eivej
Company: JP47 wl` e- ilc`✓da""3 '*"CJ
City: _Sen�l�C'_-� State: F/
Zip Code: c{ S� -7 Fax:
Phone No. i 5?, 0 ` Z5-y
Address:,17�
City: WestStater
Zip Code:,Fax: ,3`GI-ZUL-/G/)6
Phone No 52v./- 04)z- AVI z
E-Mail: J e�1-awl c�G _ (,3—� Corric ,4g . ✓'
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail A",/
State or County License �S'CC ii /S�dZ
It value of construction is 52500 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
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 INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLO DA
COUNTY( ,a Im ct '�
STATE OF FLORIDA
COUNTY OF 11a),wAaCA
The forgoing instrument was acknowledged before me
this 2_7 day of__J_o. rtvc,r4 20 Z.L by
The forgoing instrument was acknowledged before me
this?_7_ day of" �J�n,i)c4 l 20 LZ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Type o enti ication
Produced _,.tee
v a� KIMBERLY A KELLY
Commission # GG 208493
Commission Expires 04-18-2022
notar
Personally Known OR Produced Identification
Type of Identification
Produced v P Y KIMBERLYA KELLY
o ° Commission # GG 2084
N c Commission Expires 04-18
o Bonded Through - Cynano
'
1•�:gFF�oQ' Florida •Notary Public
3
0
a
( g n a t u r eof Nof_ ',Offc- to xafaFltlntt ubiic e-1 If
(Si)ature#Nota Publ' tate Of'FitSi i r
Commission No.6626-d qq (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.