HomeMy WebLinkAboutWnuk GEN APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -1I
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Address:_ Y) � ? 'Z
Property Tax ID #:
Site Plan Name: Y
Project Name: In
IVhIN
Permit Number:
Building Permit Application ge y)
pp on
Commercial—. Residential V
Dff-
� - S Q2--pi)Li'-
- L4
M
Lot No.--,? 01
Block No.
.1111` �
1iiiiiiiiiii1lim
Haamonal work to be performed under this permit -check all that apply:
—Mechanical _ Gas Tank
_Gas Piping _Shutters
-I'€tectric _ Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction:
f�i Q Sq. Ft. of First Floor:
Cost of Construction: $ q Z 1 S
Utilities:
_Sewer _ Septic
Name GrYI 3d—nuY,,�
Address: 3 2- MU I G
City 1) S
State: 'l�
Zip Code: OI.Q Fax:
Phone No. 0 15 - V5
E -Mail: Q YiU Cann
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
ILUN I RACTOR:
Name,�:Ig4_� ff
Company:—W Moo
— Windows/Doors
Roof Pitch
Building Height:
C,
Address: '6 Y p I VI✓
City:I-c 0 Gi-� State: ft,Y
Zip Code: o19u D Fax: �—
Phone NO -LL - Z -1. U u (Q (p
E-Mail!!GYI'Y1 n� IC%G C—c�'Yl
State or County License
`value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGN
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HO
Name:
Address:
City:
Zip: Phone:
-_ Not
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: _ Phone:,
BONDING COM
Address:
City:
�E
Zip:_ Pho
_ Not Applicable
State:
_Not Applicable
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 OBTA
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECOIN FINANCING, CONSULT
RDING YOUR NOTICE OF COMMENCEMENT."
PSignatEureof wner/ Lessee/Contractor as A
gent for Owner Signature of Contractor/License Holder
STATE OF FLORI ,�
COUNTY OF rtl a STATE OF FLORIDAn
COUNTY OF U ea C-
Thergoing instru nt was acknowledged before me
this day of The f� r�gnoing instrument was acknowledged before me
20 by this � iv day of u of 20 2_bby
Name of pe on making statement.
Name of person making statement_
Personally Known OR Produced Identification
Type of Identification
ProelmsPrl 1� I I r e 0-1 f-0
�Qm
ire of NotaO
Commission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
ev. 2A7TM--
Personally Known OR Produced Identification
Type of Idenp icatifn n S�
Proyced �JJ ((,
burzmIn �
!-Notary�ub�c .e of Flonda ( re of N
D Walker
s ge� 225827r�Notary Public Stte of Flonda
1 2022 Commission No.. Charmin D Walk,�r 27
w : mission GGdd
Expires 0610612022
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