HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COrnr LETED FOR APPLICATION TO BE ACCEPTEu 11
Date: L �Z�q Permit Number: 1 " 1
qs
SCANNED
:_ -, : -� BY Lion
ECEIVED
• St. Lucie County
Building Permit ApplicaB 2 2 tots
Planning and Development ServicesBuilding and Code Regulation Division County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION;. "
Address:
.?-k \,z
Property Tax ID #: 34t7� i� —"O®� ®�Lot No.
Site Plan Name: Block No.
Project Name:
_ ,: . -
DETAILED DESCRIPTION OF:WORK:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping
_ Electric _ Plumbing Sprinklers
Total Sq. Ft of Construction:
Shutters
Generator
Sq. Ft. of First Floor:
Cost of Construction: $ V4- Utilities: —Sewer _Septic
Vdjn'dows/Dpors -
'l-Roof 6P Pitch
Building Height:
OWNER/LESSEE:
0'
CONTRACTOR:
Name
Name:
t-�
Address:
Compan,
City: E-=n c
Zip Coder C
Phone No. --7." 7 2 —g72 ZO
Stated.
Address:
City: State:(
Zip Code-
Phone No
E-Mail:
E-Mail �t.�l
i �l_
Fill in fee simple Title Holder on next
from the Owner listed above)
page (if different
State or County License(2-<:j,'--
t32ra ���i
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.
.
CONSTRU
° LIN LAW INORMATIONSUPPL.EM.ENTAL
.. .
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
— Not Applicable
Address:
Address:
City:
Zip: Phone.
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 O i�r/ Alen for Owner
Signature n ractor
Ze se Holder
4ese1Contraac,1c;r18s
STATE OF FLORID
STATE OFFLORIDACOUNTYOFCOUNTY
OF
The fgrgping instrum s acknowledged before me
The fo oin Y nstru
was acknowledged eY re me
20_q b
this day of 20 b
this a of
Name'f person mhking sta ent.
Name of person aking statement.
Personally Known OR Produced Identification
Personally Known /
OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Flori
(Signature of
i - State of Florida )
KAREN S. �IEJ SEN
Commission No �Npp
Forido r�® /y Public
""""
' �Y�
Commission +° e`acSt
KAREN S. NI SjfilQ
,:e%-
=•
orida•Not ry Public
Commission
Commission N GG 207484
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"�:'E°„iw;P
tt GG 207484
M Cornmis>i0n Explfes
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My Co..,
June
June12, 2022
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