HomeMy WebLinkAboutPermit app All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
1
- Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1SS3 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: -
Legal Description: 6"( C,4�� v
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Property Tax ID#: 7 erZ7 f Lot No..
Site Plan Name: Block No_
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additionalpon
wort to be pe orme un er this permit--check all that app y:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 15M ' QQ Utilities: _Sewer _ Septic Building Height:
Name [�iAl 4'J i L Name: i
Address 6(�,LyKl irlC '•1 1 Co► a a� w R Q f �fl'� 0 r%,v 19 °I- AC
City: �?Cxr �21 State: FL- Address: Qx�
Zip Code:_LCf 5_ Fax: City: t QY— 5t- L0(_A C --- State:
Phone No. 11A 7'5C1 '' t4 0-19 Zip Code:3q9S Fax:
E-Mail: Phone Na - - -
Fill in fee simple Title Holder on next page (if different E-Mail s t-Zt, a) 1 dck4d # - c
from the Owner listed above) State or County License c 8
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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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:
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 Assoc€ation 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 wgrk or record in our Notice of Commencement.., s
Signature of Owner/Agent/L see/Contractor Sig atu a of ontractor lcens older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF s��� �:�� - COUNTY OF SC' L_x"e'
The for ping instrument was acknowledged efore me The forgoing instrument was acknowledged before me
this day of rVyLC B by this�day of tm�LV'4_ 201'!( by
(Name of person acknowledging) (Name of person acknowledging)
114
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known A 4611d 6R P.mdmeed ldemtifie tierl Personally Know OR Produced Identification
Type of Identificati " `�4. MICHAEL GERNAR' Type of Identif€c t(qc�..'••., -`�-
Produced - My COMMISSI{?N#FF230$4$ Produced ° MICHAEL GER�lART
,-. - 11SSION#FF23084$
EXPIRES May €4.2019 ,•,
'?a.,�' EXPIRES h4a
Commission No. 4' '' ;' rw�'d" r Commission No] A%A19
iul xiitfW d'y$C'vxeC COrt'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
rev.
BUILDING &CODE EG LAA-9MON DIVISION
FOR17 PIERCE, F-L 34982
t: L
772-,fQ 2- S7
AUTHORIZATXON CORM EFOR CR 17 CARD W `ENT
TO: St Lucie County
RE: '16 CAkAVIDUsk
Permit #
Credit Card Users: 1.5%Surcharge added per transaction.
Payments must be received in this department by 4:00 Pik for transaction to be
processed that day, if not it will be processed the following business day.
w 'VISA MASTERCARD
Credit Card Number LI O'4 '' -, t0 W,3 5 0( cl. >
Expiration Date 0� .� Zip Code -S(H S—a
3 digit security code
Amount $ + 1.5% surcharge
Business Name: , � - - 4-A'`Cp-n i P/YA I 110if �(ur�ji If
Authorized Signature: ---
Print dame; MAVI
Phone: ( ) �q 2—
Fax: -) (o7 - _ �3 S -
Comments:
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