HomeMy WebLinkAboutAPPL WARRENAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: o(. — I ® Permit Number:
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 TYPE:
Address: ) I � 6 KQ nJ 1Je—i''i'LI (Carl e_
Property Tax ID #: 2 ,R& `-703-61 &(5 - oco - i
Site Plan Name:
Project Name:
Lot No. Iq6
Block No.
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
QQ
Cost of Construction: $ 1U, "�d 0 '- Utilities: _ Sewer _ Septic Building Height:
OWNER/LE55f E:
CONTRACTOR:
Name
Name: Y
Address: / ,M P2aciib�rd'k_l I./�
Company: d Atet�t e : � o�
City: 7"arf31- Ly&i' State: F/
Zip Code: ,3�F�t S�� Fax:
Phone No. -77c2 , 2 - z/00(9
E-Mail: X S 8C6SY 0 6e-11,360Y-h a 1,/C_
Address:_ % 5� 1�/Y45�iyl f Z
City: "Ut e- - fz State:
Zip Code: 33 "10q Fax:
Phone No S-�o / - 2007- /20�2_
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail/,��//��'�AfrlVicl�� p�e►�'����'S Cc�1
State or County License,565-/.3I 1SW L"),2 (5
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
C1��L�Ii[ �I7LI�L�PI��31
Name:_
Address:
City: _
Zip:
Phone
_ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
City: State:
Zip: Phone:
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.
1 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 1 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Ci L?GcC}��l
The forgoing instrument was acknowledged before me
this 1.1 day of 1—C-'_(�-) 20aO by
af
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Sigr)Ature of Nat%ry b ' e ofoF*lda�LYA KELLY
°. tf �nJm�'� .� i GG 208493
18-2
Commission No. rni° n Aires 04-18-2022
e' onde igh - Cynanotary
o r�° Florida - Notary Public
Signature of Contractor/License Holder
STATE OF FLORIDA n / /�
COUNTY OF G;Gyl�l J J a
The forgoing instrument was acknowledged before me
this " day of t E 20�a by
II
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
of NotarVPUblic- State of F
Commission No. 76 etot�
-
ZZOZ 81 40 santlx3 uo!ss!uiw0 ' ; m
11i3N �/ A1�38VJl1i
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATIr-
COUNTER
REVIEW
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REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/ 7/ 19