HomeMy WebLinkAboutBuilding permit app , page 1tBLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
� I
Building pp Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1SS3 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:'
Address: ( r � 1' , I c-,
Legal Description:
Property Tax ID #: 1,5) - Ls: ` o /!�2v —OL9 o - LI _ Lot No. i
Site Plan Name: 'Block No.
I
Project Name:_ _
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
AA
CONSTRUCTION INFORMATION:
Additional work to be je orme under -this permit - c ec a
�IiVAC L_I Gas Tank Gas Piping
apply:
Shutters
, L
_
Windows/Doors f
Electric ❑Plumbing
O5prinklers � Generator
[nI
Roof ra
Total Sq. Ft of Construction: 2- Z.GCi
S . Ft. of First Floor:
I
Cost of Construction: $ f 3; 00C) ._ oy
Utilities:
Y
Sewer
Septic
Building Weight: 23
OWNER/LESSEE:
CONTRACTOR:
Nam Ziftro go(
Name: So4cfi
Address: !1 StC6627 d S ►-
Company: C C4 r f r1 ' f
City: S�(!I ? _ State:
Zip Code: 3 uG1Cj {ram Fax:
Phone Nodll� 1 Z OLO
Address: iLQQ
City:`
Zip Code:
Phone No. 'j Z
State.
Fax: �—
C)15
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
C4 r
State or County License:
.v.•� .•. w����ua.aw�� �a,�a vv v, 11wrt7, a ncuunucu imoure OT LOrnmencernenI is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: ....
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorn�y before
commencin,Q work or recording vour Notice of Commencement.
_ 5 nature of Owner/ Lessee/Age
ATE OF FLORIDA `-
OUNTY OF S�- 16ixz .-'
The forgoing instrument was acknowledged before me
this L 7 day of 2020 by
(Name of person acknowle ging }
(Uol� 6 . R oe��
(Signature of Notary Public- State of Florida }
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/201
51gWRO_SSV_R
sAafy ujLJ%� - State of Florida
a` Cornmisswn :r GG 307149
r3onCec; 1hrot.yh S<);dry Assn.
��AW
atu
STATE OF FLORIDA
COUNTY OF c
The forgoing instrument was acknowledged before me
thisay of Vl f/1' 20 by
(Name of person acknowledging f.)
(Signature of Notary Pu lic- State o Florida )
Personally Known OR Produced Iden ifi+ ation
Type of ldentificatian Prnrh
;�Y•.« JENNIFER DAVIS
Commission No. 1sycommissid&o6mos
111.�*miJU,,§,-FEXPIRES: February 29, 2024
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