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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLEiw FOR APPLICATION TO BE ACCEPTED Date: ",if %WI a- D I Permit Number: ©�/0�f� SCANNED BY • St. Lucie County — - - - - Building Permit Application °F�FrG Planning and Development Services qP AP � f FO Building and Code Regulation Division SN'rbo �10J 2300 Virginia Avenue, Fort Pierce FL 34982 (ec9o0p 9 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residenti'NO'13K I'll PERMIT TYPE: 112ROP.C3SED IMPROVEMENT LOCATION; Address: Property Tax ID#: z70 UDO/- 6DO Site Plan Name: Project Name: Additional work to be performed under this permit - check all that apply: Lot No. Block No. _Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Cost of Construction: $ %SO Sq. Ft. of First Floor: Utilities: _Sewer _Septic Building Height: OWNER/LE-SSEE: CONTRACTOR: Name W y rvw A we Name: KJZ Y. Address: Company: 0410 A&11L< Vh City: r, 6t State: ) Zip Code: / Fax: Phone No. Address: 4rao A" sfa^A City:- d'f�c-tiState:[ Zip Code: 3Y If Fax: Phone No i7 v -07 3 E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail .4'a" f State or Cou y License C A / rid_ f V/ 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. Name:_ Address City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: _ Not Applicable Address: City: Zip: Phone: BONDING COMPANY: _Not Applicable Address: a 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 Sign o Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STAT OF FLORIDA STATE OF FLORIDA OF NTY c5E / UQ V\J)l COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged efore me this/9day�offby this _ day of 20_ by / ,,n t�_,�220 a1 � C) ��dF— U'�(��I ((( Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of Identification Produced �—� , (0) _ (Signature of Notary Public -State of FloridaVAUG) p blo fission No. (Seal) 79 s (Signs re of ary Public- ,n �_Matmof Florida•Notarly mission # GG 27 Commission No. %6 "° XICommissio p ( October 22 n20221f REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED