HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3ermit Number: ` U�� • ���U
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Building Perm t.-Application
Planning and Development Services
Building and Code.Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 y
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPROUEMENT LOCATIt) ;
Address: Quo °Pte,
Legal Description: 1 -
U-0f /
Property Tax I D#:24� 0,6— Go 02- ( —� 0 — Lot No. ` Q
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�S4C;�IrPTION ®F WORK: MIX—
(WLP, = a(OP, — `L
O 4
0 1�l o f -� 2 l
lirco-ig,pls,Tig,)UCT14, 1NFO1MA ION:
Additional work to be performed under this permit--check all that a)ply:
_Mechanical —Gas Tank _Gas Piping Shutters Windows/`Doors
_Electric _Plumbing. _Sprinklers Generator �oof Pitch
Total Sq. Ft of Construction: 2i 3-7T - Sq. Ft.of Wk Floor:
Cost of Construction:$ Z/ b o Utilities: Se er _Septic Building Height:
OWN ER/LE=�SS
Name "r 'n Name:
Addressl� O. ".� - " yZ, Compan LL 6-
;i' `
City: yes' State-7e_0"7_ Address
Zip Code: 3 A QAt Fax: City: es State:
Phone No.77Z.—Nz —314,Dq Zip Cod 9,q
q Fax:
E-Mail: Phone N a7l z G{'S Q (5
Fill in fee simple Title Holder on next page(if.different E-Mair ��
from the Owner listed above) Stateor ounty License C3Z. 17 _1 "S
If value of construction is 2500 or more,a RECORDED Notice of Commence ent is required..
i
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 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
.improvents to our property. A Notice of Commencement must be recorded and posted on the jobsite
before t first i s"ection. If yoga intend to obtain financing, consult wi h lender or an attorney before
commeycing w r or rerorclibifvour Notice of bmmencemen .
i"
Si a of caner/Lessee/Contractor as Age t for Owner Sig atu Contra �r/License Hol r
ST E OF FLORIDA � � STA OF FLORIDA s
COUNTY OF -2 COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 7-;7 day of _c5lnnnQ_— 20�by this 7-�' day of 20 by
V(k
(Name of person ackn ledging) (Name person
( gna ure of Notary Public-State of FI(Ada (Signature of Notary Phuicic- a e of Florida)
Personally Kra .4 I(in er AC@g ification Personally Known �" OR Produced Identification
Type of Ide "o Commwssion#GG1� Type of Identification }`�i�+•p�%�.�� Klmbe*M.G8rW00d
Produced I,* :J2JIu8 16,2022 Produced -� �'_ On 0.1313175422
thro Aaron Notary. _ =
'�•` �.�� Bonded - Expires:- a 16 2022
Commission ff�++ ► (Seal) Commission No. �n m ? �n�Noiary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014