HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 1 Permit NumberN) 1a" rO�a
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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: To Select from dropbox, click arrow at the end of line e �+
PROPOSED IMPROVEMENT LOCATION:
Address: 3_2a9 VernDrlStreet
Legal Description: S j t V'er L&kj2 Arh S/D 6LX 3, Ly / O D P) 3778--2YOD)
PropertyTax ID#: 9ya-7 -7D1' 0051- 00D/1 Lot No. 1
Site Plan Name: Block No. 3
Project Name: S i I wo r lake Pa rK S/0
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
1059-// rlye.- cZnO vac/-Sidr Pv; n� i
[CONSTRUCTION INFORMATION:
Additional work toe performed under this permit-check a appy:
HVAC0 Gas Tank ❑Gas Piping _Shutters Windows/Doors
ZElectric F� Plumbing Sprinklers El Generator l] Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
op
Cost of Construction:$ �0 d Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name P rwt7iJe I D rre I( Name: TDS h E. �4frndon Sr
Address: -q30(P N y1�h �YeC' Company: Se -s E_l e&-•'e_ o f Xi I*C4e L�jJ1t�,/nc
City: FD r� Aercc State: FL Address: ).)-0L- Bell O Uenue-
Zi p Code: 3qq y(o Fax: City: J'07> ewe State: F y
Phone No. (33(0) a.5y- 7083 Zip Code: 3'9 9 foo Fax:
-77-)- a
E-Mail: Phone No. -7� ylOS- tea
Fill in fee simple Title Holder on next page (if different E-Mail:�)yesejeLSfl tll i 2 Gi Ol. Corr)
from the Owner listed above) State or County License:A:o 950-7 670, 1,300--2,P03
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: N J A Name: /V� A
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: NJ A Name: /V/
A
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 recordi our Notice of Commencement.
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4owner/ ssee/Contractor as Agent for Owner Sig�naf Cont actor/License Holder
F FLORIDA S FLORID
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ing instrkment was acknowled ed before me The for oing instrument was acknowledged before me
day ofycC. 20� by this 2 day of b-P-c 20Q by
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Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Nota `(�p�;�ccis (signature of N ark c-SlVhNti
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pr ANNA 0)103 _ MY COMMISSIO GG 022023
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Commission f' C Mld�Sa10 �2�10 * RES:Dece rl 2020
ES:Ue� a nvr =s+ Commission No. 1 �hruNotary enariters
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17