HomeMy WebLinkAbout2032_001ALL APPLICABLE IN,F 0 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I-! Permit Number:
01
w
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
PROPOSED IMPROVEMENT LOCAT ON:
Address:
{�
Legal Description: IAV\C�'nks' �V3
Property Tax ID #: �3y ' �, ' Lot No.
Site Plan Name: Block No.
Project Name: d cs
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Addition wor c to e e Orme under is perms — check a appy:
HVAC 1 Gas Tank FIGas Piping Shutters Windows/Doors
_
11 Electric E Plumbing Sprinklers El Generator Ll Roof Roof pitch
Total Sq. Ft of Construction: _ S. Ft. of First Floor:
11
Cost of Construction: $ Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
�R
Name ti
Name: I'l VL
Company:
Addres
City s State: �—
Address:
Zip Code: Fax:
City: o Stater
Phone No,
Zip Code: Fax: C9
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail: `t +flh,Kk
from the Owner listed above)
State or County licenser
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL "CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER
Name:
Address:
City.: �
Zip: _ Phone:..._
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address
City: —i
Zip: Phone:_
Not Applicable
Stater
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
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.
— WUIAO Q, 4V��-
Signature of wner/ Lessee/Cot
essee/Co r for as Aen or Owner
STATE OF FLORID
COUNTY OF'�
The f rgoing instmim t was acknowledged before me
this day of_ 20fi by
t-
Name of person making statement
Personally Known / OR Produced Identification
Type of Identification
Produced
(Sign aturl�of NBtary Public- State o`?`Fioriria 1
Commission
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE k
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
I -
4&41 -
Signature of ntractor/Licens H Ider
STATE OF FLORIQA4
COUNTY OF zk" JQ
The forQoing insLGum t was acknowledged efore me
this day of 20��by
Name of person making statement
Personally Known _4,,��OR Produced Identification
Type of Identification
Produced
ry Public -State of Florida )
JOYCE MICNA M4ARLO
MY 00111111MOM E 00 284220
NWAAp125.2022
SUPERVISOR PLANS VEGETATION
REVIEW REVIEW I REVIEW
JOYCE MICHAU&CARLO
MY COMMMION it GG 284220
O(PIR . AM 25.2022
cnd nAi Nolky Pi a 11.4"FlI n