HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ci
Date:_,� Permit Number: ` 10 "' 6S3^"fri c irk< 4N , tea Yi ri
ECEIVED
_ Building Permit ApplicatioAN 0 4 099
Planning and Development Services ie County! Permittin':
Building and Code Regulation Division _
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)_462-1553 Fax: (772)462-1578 Commercial ResI ,ential,,.
PERMIT APPLICATION FOR:
�PftQF? SDIFREiVIEiT LCAT10N 1**-
_ . .-- .
Address: L50 . 0C£AeV `be_
Legal Description: GJC? #a0_7_ -
Property Tax ID#:_ 1 1 ro �- �Q �}' dQ� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D1514A L--D DESCR
co�srluc�ctoIaRnnA- ION� 5
Mona wor to a pe orme under this permilt-cneck all that appy.
Mechanical _Gas Tank _Gas Piping Shutters Windows/Doors
Electric- _.C_P_lumbing _ Sprinklers__ _.__Generator ____Roof__ Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $4/ .m 00 Utilities: —Sewer —Septic Building Height:
OIER%LESSI:� yk by � � C"ONTRACTORg
... Wink
.+l'h_.: §•.0_ 1. ".,. .'4�' vTl'_4..x'9[a_e i_r _ ':u f Tt• L
Name/tQ A! Ov �� N Name: F2i[ 011;2es'
Address:_Z661000 So. tSGti�IN Q 207 Company:,7,0—r 50 V 4 aAS ra
City: 17-1,1SFN 6 1 Re-J(7 State:4Z- Address-./49 ZS" Sc` 61.44 c/^ c Cf
Zip Code:3 J�J T 7 Fax: � City: Pbe-I-54 Loc FF State: FC:_
Phone No. 4/OI Zip Code: 34Y' ,5-'Z Fax:
E-Mail: Phone No 772 3Y - 74)G4
Fill in fee simple Title Holder on next page(if different E-Mail 6J 0 C 0 vvl CAS f; v► o
from the Owner listed above) State or County License c(rr I 2_2
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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EY4�_Nasgh�&H.Nffi_,L CO Sl"R'UCl"OWN IfN L,4W INFO M°A�T�®N `: " -
' = , �.. .
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
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 recording our Notice of Commencement.
S gnratur f Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License H
-STAT F ptGRM i2L�oc�s- Z6iat STATE OF FLORIDA
COUNTY OF Ne��a� COUNTY OF 5�. Lv c'\A
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledges)before me
this,.7�day of]mac 2.,nn tnx c ,20_n by this day of�dl--f ,201_` by
Jessica A. Pennine V eta t 1Oz (311\�A.5
(Name of person acknowledging) e s an (Name of person acknowledging)
Notary Public ID: 515507
My Commission Expires:
- - -10/03/2020
pM-
(Si ture'of Notary Public-State of Hefiderl rZhLy2o �s/o, of (Signature of.Notary Pu ic-State of Florida)
Personally Known OR Produced Identification_ D Personally Known OR Produced Identific t
Type of Identification Type of Identification
Produced _Y2 '[Z Ny•., p t1AMARIEGWE22
Produced �V � +'��•••.•''•. 15SION#GG 022023
EXPIRES:December 16,2020
Commission No. 51S,51)-7— (Seal) Commission No. r .. ondedThrU ?'bllcUndarw tars
10 .3
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW.- REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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