HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i
Date: Permit Number:
s
RECER"D JUN 0 72097
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 APPLICATION FOR: -
PR ARM-5 I!NPR®1/EME1vT L®CATION:
Address: t �/G' ✓� / t
Legal Description:
Property Tax ID#: `� \���� ' �a 1deo -1 Lot No.
Site Plan Name: Block No.
Project Name:eke C<</ C',.-" I
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCR�I�PI"I®N ®F 1I1/OR�K:
G C (-Cex—-e c;7" e /
c
2a Z�? 0a^,C&yS G er' CI4 CIL4 ,`T -9-
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Additional
9itiona work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:
s� Sq. Ft. of First Floor:
Cost of Construction: $ *0� 0a Utilities: —Sewer —Septic Building Height:
Ol1VN ER/LE=�SSEE: 'R/ C1'tQR:
Name -2 -e 6 t�' en/ Name: 4VA 41
Address:_ 4� v�L�4Vf Company: -,4e 6a e c-'T�1'c �7�c--
city: -F. )1AC_,'; State: Address: �5� �� /3 P-.C/ k �IA-Tyr '4ye-
Zip Code: ::3 aq V 3 Fax: City: t"/"C%-e State:
Phone No. M&-V IRI'a 366 Zip Code: y3 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License 30/ 4q
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
r
511PP'LEMENl'AL C®NSTR't1CTI®N LIEN LAW 14N:F0'RMATION:
/ pp R
DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or regoLclin your Notice of Commencement.
Signature of wner/Less a/Contractor as Agent for Owner Signature of Coni-ractor/Aen-se-Aelder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S COUNTY OF -SA-, Ly c%R,
The f rgoing instrument was acknowledged before me The fo going instrt,�ent was acknowledged before me
this day of'sy�k 20\1 by this T day of Jyh .20ATby
__� OW1•M\g• 10 --�d 1 -Oyp\
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary blic-State of Florida ) (Signature of Notary Pu lic-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identif ' 1. DEgNNA
Produced Produced MARIEGNENS
�r DEANNA MARIE GIVENS '�: ;r MISSION#GG 022023
Commission No. '1�P YC0MMIfyGG022023 Commission N p, ES:Decems�§�
ru Notary Pubhc Undeters
" PIRES:December 16,2020
'•.;of F�Or• Bonded Thru Notary Public underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.