HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONY"
All APPLICABLE INFO MUST BE COMPLY. ,�D FOR APPLICATION TO BE ACCEPTED
Date: - Permit Number:
03 a�
SCANNED
BY RECCWM
• St. Lucie County
WWW _Building Permit Application Perml1019
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMITTYPE:
Address:
A
Property Tax ID #:
Site Plan Name:
Project Name: _
Residential
. i i 111-, t-
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutter's .
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Constgijlction: D Sq.°Ft. of First Floor:
Cost of Construction: $ �(2 fib, Utilities: _Sewer _ Septic
ttiog Department
St. Lucle County
Lot No.
Block No. -3
_1_Winciows/Doors •.
° Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR: ;'
Name
v
,0&,
Name:
i
Address:plo c
e.
Company:
City: Ft' R'Uc � State: fI
Zi ode Fax:
Ph erl o I- 331- C?Q,3 Q6, %
Address:
City: ^ State:_
Zip Code: a ° - Fax
Phone No
I
E-Mail:cSiJ�agMli2
I. rg
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County 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.
r:
Name:
Address:: .
City: State:
Zip:,.. ._ Phone
FEE.SIMPLE'TITLE HOLDER: _ Not Applicable
Name: "
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Address:
Zip: Phone:
_Not Applicable
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
w
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF . Sf j'U Cj)�
COUNTY OF
The fgfg�i gyinstt nt was acknowledgy0ef re me
r.20_LJ
The forgoin instrument was acknowledged before me
this a of by
this _ day of 20_ by
?l ci+ricL I:Lnt
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of I j+ficaYlIon I r
Produced 11LYle ISICIAll U//i/�)/j'$ V>;I r(Q
Type of Identification
Produced
4-4
(Signatu
to �I
(Signature of Notary Public- State of Florida )
Commisrry23,2021
'„i MY COMMISSION 111 12%�i79
11
ea)
Commission No. (Seal)
Bonded Thou Notary Wbra Undenniters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
wv. v140d io