HomeMy WebLinkAboutLANDERS PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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:
lQ Jr r'i' +� t�r /C �f
Address: 1
/ }
Property Tax I #: _ 1 �l -006 --s- Lot No.
Site Plan Name: C S rjr 1 Block No.
Project Name:
a i i/L d bice It. Vi n dca,—f-5 ,ate f ay,, -Y
E.dYy
Additional work to be performed under this perrf`iit - check all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters i Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
I
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1- G IT Utilities: —Sewer Septic Building Height:
Name el K 1-
Address: l5?Sfld/G Company: C�i'f' 1
City: / 1 '- Stat Address: 3 � c d
Zip Code: 3 Y��,- -( Fax: /if City: Stater
Phone No. 7 7 -'3-3 CT dt3 dZip Code: , 3 �ffF Fax: 7 Y&k ,ff
E -Mail: Phone No�n L (_p/ l�`-,? t
Fill in fee limp a Title Holder on next page ( if different E -Mail cce -T-ep-c7 "C".7
from the Owner listed above) State or Cou y License
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.
DESIGNER/'ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 Horne 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 wok or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Halder
STATE OF FLORIDA t
STATE OF FLORIDA
COUNTY OF {_,vt� _
COUNTY OF
The fargoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 1 day of 20 by
this day of :r. 20'D-0 by
PC
ift. V1 11Y"
C( f" it'� -
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known,.
Personally Known Produced IdemificatioU
Type of IdentificatioTn. "' T "'' CHARLOTTE M. WALTERS
Type of identification "? CHARLOTTE M. WALTERS
Produced �: Commission # GO 921080
,�o
Produced ssion#GG92108Q
zpues ovember 24, 2023
hEOF�'�BandedThru F Insurance8W-385.7019
Commission No.
m
y'FOFd:°�� 23
Commission No. Bar�ded��FaExpires erinsurance $40385701
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