HomeMy WebLinkAboutPermit for 122 Queen Eugenia CtAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I ' Permit Number:
- 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 —i ---
PERMIT APPLICATION FOR:
I
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PROPOSFDIN:PROVEME.NT:LOCATION; iR
Address: i :a'a L �- j Cc) 1 C,
Legal Description:
Property Tax ID #: LA 0c) LA U. CQ Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�.'.DETAILED DESCRIPTION OF WORK:
I Le Aiztr- I V -C- ior--) I
TR.CTION. INFORMATION:,
onal work fio—b6'per Ormed to i
,---Kechanical Gas Tank
— Electric Plumbing
Total Sq. Ft of Construction:
Cost of Construction:$
permit --check aTtf-at apply:
—Gas Piping _Shutters
Sprinklers — Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities. —Sewer —Septic Building Height,
!'E
OWNER/LESSEE :CONTRACTORI
7 % K�R 1112
F
Name 01 t2, C% I as LL C
Na c, i o f L "Ir
Address: Lk 3 fit 1 C--
Company:cr� X00' C-1 a
city: state: FC,
Zip Code: ,3LJq Lig -"K31 Fax:
Phone No.�W-30 -1 Haa,
Address:GIC Cc-bc�rm
City: -_CA + Pl� Ce State: -EL
Zip Code: 9S I — Fax: -1-ID-901 -t>3'--j
Phone No I --A- L3Y - Q9 SO
E -Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E -Mail CCNU t Gti 'J C c4it C'i
State or County License_ I 'A- t"-'-100
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
12 U. AL �7NSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE MOLDER: 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 recording our Notice of Commencement.
L G--
Signatur of Owner/ L s e ontractor as Agent for Owner
; Signature6t Contractor/Li ns' older
STATE OF FLORIDA -STATE
OF FfflDw
�
COUNTY OF 3', Lultk
COUNTY C I
The forgoing instrument was acknowledged before me
this day of ��b, r 201-120by
The forgoing instrument was acknowledged before me
this 1 day of )r` 20 19 by
(Name of person acknowlecYging)
(Name of person acknowledging }
(Signature of Notary Public- State of Florida }
(Signature of Notary Public- State of Florida )
�
Personally Known OR Produced Identification
Personally Known o u d e, ti ca, o
Type of Identification
Produced „",
, PU@{�i� BOW
Identification ,,,Yp.,,
"' U®r, ; SUSAN A. BONEN
NProdu d a�. o-
♦•iP
SUSAN A.
' *
A�� Notary Public - State
Commission No. eal) Commission # FF 2
Notary Public - State of Flo
f Florida ` ' = Co mission # FF 23107
NP Y 4 -. �
1WI?nm sion No. c o�nm, Expires Jul 28,201
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My Comm. Expires Jul
8. 2019 ,9
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