HomeMy WebLinkAboutRotundo 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
IR •
-- - — Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT APPLICATION FOR: r�
PRo _ _ _ E T_ ION:
Address: ` `� 6�� , p( �� � Z
15
Legal Description: �tNC_S
`0. ln0.1l�Q�.`lM�
Property Tax ID #: Lot No.
Site Plan Name: Block No. —.—
Project Name:
Setbacks Front Ahk Back: Right Side: Left Side:
PTI =
Additional work to be pertormed un ert ispermit-check all that appy:
_Mechanical _ Gas Tank _Gas Piping _ Shutters —Windows/Doors
•
Electric _ Plumbing _ Sprinklers _ Generator Roof�Z�itch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 7 SW i
� c� Utilities: _Sewer _Septic Building Height:
CTOR:
Name VPVY,Name: W
Address: k Company.0
City: -Szk kutte State: Address:
Zip Code: 3t.;Z Fax: . City: State:
Phone No. %�% z'-'�A 3 93 Zip Code: �4yg7 Fax:
E-Mail: �'IT• Phone No ^%7Z`
Fill in fee simple Title Holder on next page ( if different E-Mail S L
from the Owner listed above) State orCounty icense %�
If value of construction is 2500 or more, a RECORDED Notice of Commencement is re Tired.
SUPPLEMENTAL CONSTRUCTION
MORTGAGE COMPANY: of Applicable
Name:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
BONDING COMPANY: _Not Applicable
FEE SIMPLE TITLE HOLDER: 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
commenclin or recordin our Notice of Commencement.
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SignatuVol Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Hol
STATE OF FLORIDA �` 1 ' _
COUNTY OF �T WUp
STATE OF FLORIDA I
COUNTY OF ��— 1� �G, L
The fQring in ument wa ack wledged before me
The for oin in ent wa acknowledg fore me
this L day of 20n by
this day of 1� 20y
iNAN �AC&,Sn
U 10 LZ�-
Name of persjfi making statement.
Name of persorLDiaking statement.
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Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Iden . cation
Type of Identification
Produced
Produced _ 5 —k—X _
(Signature of Nota Publi - St a ASHLEY FRECHErrE
- Notary PuNk-BtIDeofFWrid
Commission No canmisso aGGm126B
' Call YComm.E0res Feb8.202
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PLANS _
VEGETATION
SEATURTLE
MANGROVE
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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