HomeMy WebLinkAboutNancy DixonAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
COUNTY
F I n R 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 Number:
dui ing Permit Application
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Commercial Residential
Address: 73lS S J. e ianj r'?lv`c(- Drive-, Gr4- j&,,ce, /t--( JV7eZ
Property Tax lD #: 3 5 07 - 7 C, 2_- U U 03 -- G G G - / Lot No.
Site Plan Name: Block No.
Project Name:
I DESCRIPTION Of WORK:
-_X�-F A\� �
)4
O l 1 al�{ Oc-1 f �k' C--AA
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters , Windows/Doors
-ilectric _ Plumbing _ Sprinklers _ Generator — Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 4?, IFUG : o Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE-
CONTRACTOR;
Name Nc j, D, >c
Name: a v�•1"Z-�. ��=
Company:
Address: '7 '3 L (L 0-c' Dr ky %,
City: rim rtst, State: PL,
Address: 1'7 Zg St-1 A al lkIf" (Ld
Zip Code: ?4 g 3 Fax:
City: L_vc,i�e, State:
Phone No.
Zip Code: 34-95 2- Fax:
Phone No S, I `' a b ,30y
E-Mail d rct- r e'dD Nm(i 1 �Qv"
E-Mail:
Fill in fee simple'Ttle Holder on next page (if different
from the Owner listed above)
State or County License EC.l3 Q e 4 (� Z
It value of construction is 52500 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 CONST UCTM MEN tAW INFORWTM:
_ Not Applica
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
_ Not Applicable 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 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 SfTE BEFORE THE FIRST INSPECTION. W YOU INTEND TO OBTAIN FINANCING, CONSULT
Ana YRU I D ! "MFO nR AN A-rrnD FY RFF(WF,RF_Cn9I101ftG YOM NOTICE OF COMMENCEMENT. -
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of 6niji6o&Fcense Holder
STATE OF FLORIDA
STATE OF FLORID
Lur—r
COUNTY OF
COUNTY OFT
The forgoing instrument was acknowledged before me
The for ing instrument was acknowledged before me
this day of 20_ by
this Vrday of _ M&Z 20a by
i14
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
L�
Produced
Producedl�l� I 7
i
(Signature of Notary Public- State of Florida)
(i ature of Notary Public- State of
Commission No. _ (Seal)
'tarrn�"' FAYE SULLIVAN-1
•�
;` ?) Commission Jat
Commission No. Notary Public - State
My Comm. Expires Ap
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
RPM
MANGROVE
COUNTER
REVIEW
REVIEW
REVfE`JV
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED'
Rev. 2/7/19
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