HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 51301 Permit Number:
SCANNED
BY
o St. Lucie County
Building Permit Applica
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
PERMIT TYPE:
Address
Property Tax ID #:
Site Plan Name:
Project Name:
RECEIVED
MAY 3 0 201g
Lucie county, Perr
Residential X
CTLot No. I
Block No. -JJL_
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof T Z Pitch
Total Sq. Ft of Construction: loon Sq. Ft. of First Floor: l o o
Cost of Construction: $ 1-1(950 Utilities: —Sewer _Septic Building Height: �5 _
OWNER/LESSEE
CONTR4CTOR ";
Name
Name:
Address:
Company: S S
City:P. pff±Stater
Zip Code: Y2 Fax:
Phone No. %-7% -32�I�
Address:
..
City: State:L
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail urJurcolu
ffo I
• Com
State or County License 2
If value of construction is 5z5uu or more, a rmwxueu rvancn ui
If value of HVAC is $7,S00 or more, a RECORDED Notice of Commencement is required.
y
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
— Not Applicable
Address:
City:
Zip: Phone:
State:
BONDING COMPANY:
Name:
—Not Applicable
Address:
City:
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 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.
4 J,� �
Signature of Own r/ Lessee/cflpaor as Agent for Owner Signature of Contra or/Ucense Holder
STATE OF FLORIDA p STATE OF FLORID
COUNTY OF aIIUri COUNTY OF 1Ia�'I�
The forgoing instrument was acknowledge efore me
this day of 20 by
Name of personmiiking tat ent.
Personally Known V/ OR Produced Identification
Type of Identification
(Sig�i tute.o€ 16taryPublic-Stat 0t,6 ida) KATHERINE HAVENS
MY COMMISSION #GG165
Commission N SeaWIRES: DEC 04, 2021
Of Bonded through 1st State Insoi
REVIEWS I FRONT ZONING
COUNTER REVIEW
RECEIVED
DATE
The r inginstru n as acknowledge efore me
thisday of l 20Tby
Y 1 Cfh
Name of person making tement.
Personally Known OR Produced Identification
Type of Identification
Produced
SUPERVISOR PLANS
REVIEW REVIEW
A Notary Public -State of F ri a
t
��O z4`w:?'. Vm`nE
No A«through
KAl'HERINE HAV
1st State
VEGETATION
SEA TURTLE
MANGROVE
REVIEW
REVIEW
REVIEW