HomeMy WebLinkAboutPERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
i r • -
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercia
Residential
Address: Dkxh✓\ ['S'�A
Property Tax ID #: 3y'o3 - S Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
:a 1u Kn.0
Block No.
Additional work to be performed under this permit- check all that apply:
-,XMechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric �,_- Plumbing _ Sprinklers
Total Sq. Ft of Construction: i �(� C)
Cost of Construction: $ oc (5� 060
Generator -X Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name aeA C-ec"rAw
Name: -1�' /J. C�-►�2�
Address: 5SI5 JJ J G`cdf,
Company: �wzc. �,ciIdcrs, G
City: ?51- State: _
Zip Code: 'j4AW3 Fax:
Phone No.
Address: $ll Ew Psu Q 1 LI&
City: V"'t- cS' - State: �L
Zip Code: 3ggss Fax:
Phone No U- -7 U6s ,
E-Mail: gttjctoL rArA R7G1mci4 , c01-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail S�
State or County cense CG.,L JS"a.gJ3q
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: _ Not Applicable
Name: 4"s 0aI(
Address: 10\40 a-y'(oor Or'aoY_c,° De�%v-t,
City: ,.h D- do--- State: VL
zip: 33qg3 Phone 5q- (aa'g-- t035
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
Not Applicable
State:
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NQTICE OF COMMENCEMENT."
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411-4 P��
Signiffture of Owner/ Lessee/ ntractor as I&nt for Owner
ctor/LicenseAAolder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF CALK 6(�_-
COUNTY OF S-Vl,.—kCit_
The forgoing instrument was acknowledged before me
thisa' day of %'L uuy\ 2020 by
The for oing instrument was acknowledged before me
this day of JAW QAA 207-0 by
�o1nt1 rl�-hoC1�1 C"� t�2
J O `) n
Name of person making statement.
Name of person making statement.
Personally Known _� OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- tate of Florda=)
p�MY
Commission No. COO �C)�
- ----
.::Y,'M BRIANNA GR
� �� MY COMMISSION
EXPIRES: APR 'Bonded through 1st St,
7G5�,
re of NotaryPublic- State of Flori
$lion No. -I
a BRIANNAGN
COMMISSION i
f EXPIRES: APR
Bonded through 1st S1
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19