HomeMy WebLinkAboutBuilidng PermitBuilding Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: Mo-lLq O101
Property Tax ID #: 3 Sal - 30i —
Site Plan Name:
Project Name:
(- uyl LA ycg=� Gt, o YL
c C�
Commercial Residential
CBDG Funding
—/W F-i-
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
(Affidavit required)
Lot No. r`. -u
Block No.
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Address: -1 CP 'l a C f .rl�.�-t2�� WO-C,
City: P-SA- state:[—::r
Zip Code: -3 I+q W Fax:
Phone Phone No. la c� 8 S J� !1S E-
Mai l: �C��'Yl I�i�nO Qbe > C bwe
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: ��
Company: t t DQ 6
Address: 4,3,5 nJW
City: P-SL State: _
Zip Code: �L[ga:' Fax:
Phone No I13- q(o(b -7
E-Mail F D \niPJ(D c-4d 0C.YC&2 0')rSSi
State or County License lJ!
It value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phon
FEE SIMPLE TITLE HOLDER
Name:
Address:
City:
Zip: Phone: _
State:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencing work or recordinia vour Notice of Commencement.
Signa Contractor
ure of - or - O ner Builder as applicable
STATE OF FLORIDA
COUNTY OF �SA- I
Sworn to (or affirmed) and subscribed befogre�me of Physical Presence or Online Notarization
this 10 day of MWrC+,, 20_�-'-by
Name of person making statement.
Personally Known OR Produced Identification
Type of Idenntif�ication roduced
(Signature of Notary P blic- State of Florida) a
L l � b q( ) 0W P Notary Public State of Florida
Commission No. fij I �7j Seal =`r; Daisy Tomlinson
MHH171884n
ate° Exp.8/31/2025
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21