HomeMy WebLinkAboutBuilding Permit Application (2) ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 4_
Date: Permit Number: . !/RS 3N
Building Permit Application i
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
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Address: SRU? �)QW DODb / U90 C_lC
Legal Description: nAU 6 1,_YN R C LU,f3 K- eZ AT Twp—13 Ltd 11' Lbs
Property Tax I D#: bN 93- Dcb- P Lot No. 3
Site Plan Name: Block No. 9
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work toe e orme un er t is permit-c ec, a appy:
HVAC 13 Gas Tank ❑Gas Piping Shutters Windows/Doors
Electric Plumbing Sprinklers E_Generator Roof Roof pitch
Total Sq. Ft of Construction: 10 1h S . Ft.of First Floor:
'Cost of Construction:$ �, ��� Utilities: Sewer Septic Building Height:
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Name '-ThLYn WS Sch men heR5- Name: 3 AD S, &N9)
Address: 3RUP -I/0Q b000b V-111AE Company: OXODUi'lC9 JIT17G d 1.�T1r
brn 4
City: Vfib 12T 5r- Luc.-Lc State: Address: /q13 S4J .l HIEDR r b AS UE
Zip Code: ZVIS O Fax: City: AAT ST 1 LLt C.TC State: FL
Phone No. 5/(n- L f0-- /q 7.o Zip Code: �- WSoQ Fax:
E-Mail: /vC o ATZ•. 6-M Phone No. 'J74- _3'3S- q5.50
Fill in fee simple Title Holde on next page(if different E-Mail: _bLE/nFI y Cr�R� �111Cr�is7�s /JG.CJ»A
from the Owner listed above) State or-Get -License: SCC d 3 a 513
1.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.,
vSL1P�LEMENTALCONSTRU.�'TION,LIEN LAUV..INFwORMATION � �t �,r� ����y� �Jr>r��-s ���'� {,� w
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: V'
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 thepermit'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 Amendment's.
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 firs ' spe ion If you intend to obtain financing, consult with lender or'an attorney before
comme in wor re rdin our NotXb of Commencement.
Signature of Owner esus a/Contractor as Agent fo Owner Signature of Contractor/Li se Holder,
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �5TI—aci- L' COUNTY OF 5T LI c"T8'
The forgoing instru ent was acknowledged before me The forgoing instru ent was acknowledged before me
this Nay of 0 A2 ,20(F by this J2 day of QG6A 20 /�' by
Name of person making statement Name of person making statement
Personally Known OR Produced%pigip i 1✓ Personally Known�_OR Produced Identification
Type of Identification ,�,§��'.Irlb Type of Identification
Produced Ot 661(1-$�It r I�'�CQN�IISSION#GGaTJ376 Produced
N o� ES:March 23.2021 4y Pue
ed Trnu Su*t NOUN Services 20....,.�/c, �.,; DENISE LEMAY
* w MY COMMISSION#GG 077376
A �r EXPIRES:March 23.2021
(Signatur of Notaa0ry Pu lic-Stat of Florida) (Signature of Notary P�btii�° t edf dtciaf¢et�fotaryServices
Commission No.(31s D'17�r/1� (Seal) Commission No.06 67139b,' (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ! REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17