HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c,
Date: 3 34��a. Permit Number:
RECEIVED
- Sualdeng Permit Application MAR 3 0 2022
Planning and Development Services St,Lucie County
Building and Code Regulation Division Permittin
2300 Virginia Avenue,Fort Pierce FL 34982 _
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR
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PROPSED tiPR1�ENiE1 'IGATII. _1�, z.,.., `..., .._. .
Address: Lo
Legal Description: R i K I n C)+
Property Tax ID#: ( � C Lot No.
-Site Plan Name: 0 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under t is permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_Electric Plumbing Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ /,`f' Utilities: _Sewer _'Septic Building Height:
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� I PA,L�SS�E
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Name Le Name: _
Address- C Company:
City. St e. Address
Zip Cod Fax: City Stat .
Phone No. 1 Zip Cod : I J Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License F
X
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
f SUPPLEMENTAL CONSTRUCTION LIEN LAW INF.ORMATI'0N
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
F Name: - Name:
Address: Address:
City: State: City: —State:
1 Zip: Phone Zip: `. Phone: i
j FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
fI Name: Name:
Address: Address: '' i
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City: City:
F:
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 orinstallation 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 v 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. j
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z; 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
"VIARPIING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COr`ArAEPICEMENT RRAY RESULT IN YOUR iPAYWC
' T1,710E FOR BINPROVEM,EWTS TO YOUR PROPERTY. A NOTICE OF COM MENCEMERIT It7FJ5T SE RECORDED At
POSTED 0111 THE JOB SITE BEFORE THE FORST BR15IPECTOON. OF YOU OPfT�d'D TO OBTAIRf FIRfANCIRIG, COPISULT
viq t H YOUR LENDER OR API ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMrS7EW&E_M t\I T_"
Signature of Owner/Lessee/Contractor agent for Owner Signature of Contractor/License Holder
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STATE OF FLORIDA ) STATE OF FLORIDAc
COUNIYOF `�. IL(, e, COUNTY OF 1AIG i
The forgoing instr ent was acknowledged before me The forgoing instr ent was acknowledged before me
this day of i ')�, 20,�d by this I?C day of�—J 20 � by
f Name of person makinggssf�tement. Name of person making/statement. l
i Personally Known F✓ OR Produced Identification Personally Known IJ/ OR Produced fdentinca:ien f
Type of Identification Type of Identification
Produced Produced
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(Signat re-of Notary Pubic St nature of Plotary Public-State of
l' ogat•v, o ary PuC1it State e!Floral a.z'ru� \ ,P icS�7e c:' cz
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Commission No. (;�`, . � 1��5 '(S'� �� C mission No. c� flledeld ; e'3�' rasa L ut;e:. d
^ � cmmissicn GG 302065
,��or 1=° nrpies 02n412023 9 ,'?oo.4`
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE i
COUNTER REVIEW REVIEW REVIEW REVIEW RE�IIEW i REVIEW i
DATE i
RECEIVED
DATE
COMPLETED
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