HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APP!,ICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
,gate: Permit Number:
SCANNED?
_ - St ' LuceCniinh/
Building Permit Application
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
PERMIT TYPE:
1. PROPOSED. IMPROVEMENT LOCATION: " I
Address: I (00LJ -
Property Tax ID q: d.JO 5 - 5W - W 13 - 00O - y Lot No.
Site Plan Name: Block No.
Project Name:
CONSTRUCTION INFORMATION:
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 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ I rJ OW( oo Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:,,
"CONTRACTOR
Name C W e olxc4p"r
Name:
e, N
Address: k5go I - Oi u
Company: H o4W
a LIB
City: State:
Zip Code: ?)y' 45 Fax:
Phone No.
Address: k0 _HIALON
City: R P_YCQ
Zip Code: aAQFia
Phone No 1 -
State: �l
Fax: r ]R-LCn)-
9'
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail tClffe S pna:: "u k
P (o 1. cow
State or County License VC
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.
SIJPPGEMENTAL CONSTRUCTION LIEN LAW INFORMATION: ;
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY:
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone
Not Applicable
_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 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."
Sign aur Owner Le see/Contractor as Agent for Owner
Signatu o Contractor/License older
STATE OF FLORIDA
STATE OF FLORIDA
\ - ��
COUNTY OF C%
COUNTY OF
The forgoing instr ent was acknowledged before me
instru t was acknowledgd before me
The forr�
this day of . 20 by
o I,Lrnra�.. b c_
_oing
this - day of 20y'Y by
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Name of Orson making statement.
Name person making statement.
Personally Known `" OR Produced Identification
Personally Known` OR Produced Identification
Type of Identification
Type of Identification
Produc d
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�y
D �eoAo�'�a
(S tur of Notary Public- Stately Florida)
`(Sign Lure of Notary Pub State of Florida,
Commission No, y,Y�::-•. LASHAI,aP)GRa°J-RAHMIING�
Commission No.°�9••• LASHAHNA IIJGI(.b.B�+�HMING
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Imo' IdY COMMISSIONSGG 275060
'vi R S: December"Z0, 2022
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REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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