HomeMy WebLinkAboutBuilding permit app All APPLICABLE INFO MUST BE COMPLETE FOR APPLICATION TO BE ACCEPTED
Date: �'S Permit Number: 1141- Oa�1
: f b ; R E C E I V^D J N 13 1737
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 APPLICATION FOR:-
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PROPOSEDI,NPR �/EMENT�LOCATION � �� M °ry � r � , r
Address:_;7R O r
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: t' _3 p/- 6 6 S' 4 1 Q S` ( 6G 0 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additionalwork to be pertormed under this permit-check k all that apply:
_Mechanical _Gas Tank Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ S! Utilities: —Sewer _Septic Building Height:
COIN%NCR/LESSEE - swn
C®NTRCT Rf � ar
W'?Ae . "''. "�`'�'a_
Name Narrie
Address:'% / Company:
City: 3 ��s7State: Address:.: u.
Zip Code: Fax: City: State:
Phone No. , �� ' aa� '��� Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S4:IPP,L yMENL G�NSTRl1C�TIDN LIEN L.A�U1/ INFQR�11lIATIp;N: W;, , .
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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: _Not Applicable
Name: 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 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 attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S� . ��c•�� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledge .before me
this day o13<5a d- 20]l by this day of 2 _ by
\9"\\o,gva (g 1 f
(Name of person acknowledging) (Name of person acknowledgi )
(Signature of Notary Pub' -State of Florida ) (Signature of Notary Pu lic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identificatio
Produced L L_ Produced
�'•"•�="a''• DEANNA MARIE GNENS
•
Commission No. M ISSION#GG022023 Commission No. (Seal)
� � �*'-
RX December 16,2020
•'•:c $••' Bonded Thru Notary Public undenwitera
REVIEWS FRONT ZONING- SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE II
RECEIVED - , L3 'I l I't6 VI A'1
DATE
COMPLETED
Nev. 4
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