HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED,FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
• JAN 2 6 2022
Lucie
Building Permit Application
Planning and Development Services St Perrmittingnty
....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: 5 q L 3 ��(Gly �P I &�I P ��� �i`P ftt, • -1 59n S I
Property Tax ID#: Lot Na a 1 +ao1
Site Plan Name: Block No. l
Project Name:
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator K-Roof l Z Pitch
Total Sq.Ft of Construction: 9 Sq.Ft.of First Floor: i�a
Cost of Construction:$ 1 b�5-6r*) Utilities: —Sewer _Septic Building Height:
_ fivJin
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Name I Name: ViQ,\j -dez2fl-w,
Address: J-113 �t t A, NJ Q- Company: \-T-
E.
City: 'F0c�- State:_ Address: q3 fob 5e e o rWnureL AUQ_.
Zip Coder Fax: City: mg-r-k State:,
Phone No._�-j 2- 1 a- 2 k l l0 Zip Code: ,Jq g9 Fax:
E-Mail: Phone No'fIa -,P&&- L 9S-
Fill in fee'-simple Title Holder on next page(.if different E-Mail j D i C'AM
.from the Owner listed above). State orCounty-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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _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 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 A AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF CQ MENCEMENT."
Signature of Own6 r seKontractor as Agent for Owner Signature of Contractor icense Holder
STATE OF FLORID STATE OF FLORI l
COUNTY OF '(Y�n,r-LVl COUNTY OF �f�C�Y-riR
The forgoing instru ent was acknowledged before me. The forgoing instrument was acknowledged before me
this day of Gr l 2012 by this�day of 20�by
L
Name of person makin s tement. "Name of person making to ement. m o
LL Personally Known 1✓ OR Produced Identification Personally Known V�R Produced Identification o
y Type of Identification Type of Identification
o Produced Produced �C�C�J C1 0
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mE� rn °•
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022 Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) m
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Commission No. G (Seal) Commission No. L v!y (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW . REVIEW REVIEW,.:. REVIEW REVIEW. . . REVIEW
DATE
RECEIVED
DATE
COMPLETED
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