HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i O _ -� Permit Number:
A =- �
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial . Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMEN.. LOCATION. ' j �s .IR VT
Address. intw - D -C)1
Legal Description:
Property Tax ID #: , c�J -�i�' 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
[DETAILED DESCRIPTIO_N-0 F W0RK:
4S 's CC- i I 0 IL(o
CONSTRUCTION INFORM'AT]O _ 2s;
Add itionall work to er er�om_ec ui �ert ispe-rmit -�cTthaf apf ~
'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: $ 1010 _ C)cli Utilities _ Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR.° wa. V
....
Name fitv. fy-\ I`l Name .
IAC G ,a,
`% Vii. -1G i<
k�
j,y
f to do CCR d lof\S 6 FL_ 1
11
Ci State: ' -G.e –
Zi p Code: 3 a-9 Fax: City: State: l
Phone No. `3�� ^� Zip Code: 3�1 _ Fax:—1a^S01—S�+
E-MaiI:Srf_\1 Vk i )LW C I'�F-. I{ S t I _... Phone No 04 CA
Fill in fee simple Title Halder on next page ( if different E -Mail CDCCI ctI C d
from the Owner listed above) State or County License C_J\ k �1 00
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
— Not Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
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, wails, 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
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Signature -df Owner/ Lesse ractor as Agent for Owner
Signature Contractor/Li` se older
STATE OF FLORIDA r,
STATE OF FLORID
COUNTY OF ,� .� tib-� _
COUNTY OF
The f rgoing in �m t was acknowledr7efore me
The fo)joing ins u' e t as acknowled efore me
2 by
this dayo( it Zi) by
this L -day of�tt��St�+�
A L—
( eo''(��erson acknowledging
(Name of pe on acknowledging
i f N_.
(Signature of Notary Public- StateofFlorida }
(Signature of Notary Public- State of Florida }
Personally Known CIR Plrodgced idqijtificaL_on
Personally Known ✓ G4W.F,oduce is tion
Type of Identification ,..��yp,, `
�c,, KRISTINE HOPKINS
Type of Identification .Q *� p���KMSTINE HOPKINS
Produced '`a -
Produced ;�o`�
Notary Public - State of Florida
blit - State of Florida
' Commission
'; �= Co�� +is 'on G6 086127
Commission No. "'."/ My Colza Aires Jan 25, 2021
,� GG 066127
Commission No. %..� ,•`�� AA Comm-
�,�. y s Jan 25, 2021
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REVIEWS
FRONT
ZONING
SUPERVISOR PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
REVIEW i
-�
DATE
RECEIVED
DATE
COMPLETED
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