HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE NF0 UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: J Z� / Permit Number: 1ALos OLic 1
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St. Lucie County
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Building Permit Application
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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 Residential_
PERMITTYPE:
Address: OS / /Y%/yID�'DL�l� .B/lr�
Property Tax ID#: I3.3S' 2,30 - 0o0l - I)oo- L Lot No.
Site Plan Name: (%S7_4rG/1J Block No.
Project Name:
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Additional work to be performed under this permit- check all that apply:
Mechanical —Gas Tank _Gas Piping _Shutters Windows//D ors
Electric Plumbbiinng, —Sprinklers —Generator s Roof S 7/ Pitch
Total Sq. Ft of Construction: / % 3 Sq. Ft. of First Floor:
Cost of Construction: $ / Z�_ 0� Utilities: Sewer XSeptic Building Height:
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64Vf111ERflESSE #: hhF
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Name ., 5 Fr2 /--A)
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Name: i�/g-U/B C_Ywf76A)
Address: qsw( L�/�/baK1J�6_� /�`
Company: T),4 f6 0�%le-1-'14 el;T'�C-
City: 0Qge'e State,4/
Address: i
City: o State:)r/
Zip Code:Fax:
Phone No. 7 �%y �i 0/ �j /y
Zip Code: 3 5i5-/ Fax:
E-Mail:
Phone No- y lO L
Fill in fee simple Title Holder on next page ( if different
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E-Mail ///.q1�/
State or County License eAr / 7 .S✓3/sa
from the Owner listed above)
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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW
INFORMATION:
DESIGNER/ENGINEER:
Name: _1'e)U0
_ Not Applicable
cif
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
i/t . Z3o
dress:
City: �y
Zip: ,,p4 /a p Phone-772,
State: .L •
SSA 36f5
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 thepermitholder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an 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 IMP OVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON JOB SITE BEFORE THE FIRST INSPECTION. IF YOU Ir END TO OBTAIN FINANCING, CONSULT
WITH YOUR L&NbER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/ Lessee/Contractor as Agent for Owner
SlgnatdreoFlfclfitractor icense Holder
STATE OF COUNTY OF FLORIDA
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STATE OF FLORIDA
COUNTY OF
✓was
The forgoing instrument was acknowledge t before me
The forgoing instrument acknowledged before me
this ZI day of J1AWVJ 20 // by
this _:Z�Lday of J& p� 20j by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification �� �
Produced \ice
Type of Idencasionf�,
Produced cl-.alb
(Signature of Notary Public-S to of Florida)
gnature of Notary Public of Florida )
Commission No.
Commission i ncHAHNAINGRANfd11NG
?==. ,55
LAsvWNAINGRAM•fZANMING
•:,, MYCOMMISSIONb
,2'P'`": ISSION#GG275060
.: l•20,2022
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