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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST B�E7COOMI Date: (� TO BE ACCEPTED Planning and Development services ai. Luae �ounry, rerr Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 1� PERMIT TYPE: �S 14r-e'e r,�Hti 4/41-? k— Property TeX ID#: IIL'i:_o `1 noI 6, ©©© :L Lot No. Site Plan Name:y-� P- 69 (�=_ Block No. Project Name: u7z> f G r- Addition worktobe performed under this permit -check all that apply: — echanical Gas Tank Gas Piping Shutters Windows/Doors lectric -0-lumbing " _Sprinklers _Generator _A6of Pitch Total Sq. Ft of Construction: / 2 Sq. Ft. of First Floor: Z2 Cost of Construction: $ 2.5r D Utilities: —Sewer Septic Building Height: Name �070�-rco Ve Pens CGf Address: - 'City:" �C� r`�LcrCicGL State&% Zip Code: Z e2-&A9Zax: Phone Now E=Mail: - Fill in fee simple Title Holder on next page ( if different from the Owner listed above) Name: Company:_ •oo c0. /�v City:, / o-7 rGc . _ 'State:�L Zip Code: 3 cf-Y S- 2- . - Fax:_ __ _ Phone No i .%2- �52.2-- lli`�f State or County 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. ,. DESIGN R/ENGINEER:, _ Not -Applicable „.:. Nam r ..r.�"r"..'... _. wMORT,GGAGE COMPANY: _ Not Applicable Name AddrZs`0`' t Adr�re k7 City: State: Zip: ne-- °° -. — City: �► / State: -ZIP... - .. :-P.ht FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: BONDING COMPANY: _Not Applicable Name: 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 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." - J fe Signature net/ essee/Contractor as Agent for Owner Signatur o a or/License Holder STATE OF FLOR STATE OF FLORIDA COUNTYOF .LUC'.lE. COUNTY OF The rgoing instr this 17day of. ent s acknowledg before me 2 by The for oing instru e t acknowledg efore me this _Wdayof�J by pp^^ ICJ Name of person ma ing state ent, Name of person making stat ment. / Personally Known OR Produced Identification Personally Known OR Produced Identification ✓ Type of Ident' ea ion Type of Identific Produced ' 01 Produced L• �. (Signature of N IELSEN (Signature of Notary Public -State of Florida ) Commission No. �� =State of Florida -Notary Public missiorj`�Glis 207484 Commission No. ., KAl 8. NIELSEN 0`1>^'°�'� a - My Commission Expires ?n°itn`� _ _-- 3 gState o on a -Notary Public E Commission # GG 207484 June 12, 2022 y " "'° n"`p. June 12, 2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATI COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 2///19