HomeMy WebLinkAboutPERMIT APPLICATION DURDEN 1All APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - -,)aq 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 APPLICATION FOR:
PROPOSED INPROVE MEN, 10CATION»
Address:
Legal Description: - t) y L -/I Zo i 9
Property Tax ID #: 1301 4e2-3— 6 inin ! 60 -2. Lot No.�
Site Plan Name: Block No.�
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers — Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ C2 -2�0470
Sq. Ft. of First Floor: _
Utilities: —Sewer _Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:L,
Address: � :A- A V-e-
City: F� . State: F' -
Company: "�►^(� '!1
Address: Cr
Zip Code: . 32A 9 :: 1 Fax:
City: � l Stater
Phone No. - U - 01 -2
Zip Code: Fax:
E-Mail: � 7
Phone No '7 `7.---
E-Mail "- J I" tJU,1► 1,6 �% � ' . L��►
Fill in fee simple Title Holder on next page ( if different
State or County License �fF, _ ®_ �
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to ao the worK dna rrrbldrrdUVrr 0�
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
structure. Pleconflict
se c consult withpyourHome Owners Association
tandrreviewyyour deed for any restrict onat s which ay applyhibit such
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 OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent f r Owner Signature of Contractor
STATE OF FLORIDA STATE OF FLORID
COUNTY OF 75 �� ,k ( � �, COUNTY OF
The forgoing ins ment was acknowledged before me I The forgoing instrumentwas acknowledged before me
this lf--, day of this It' day of I ��- C-, 20..
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature otfilMary Publi State of Floric
— ---
COm S. KARLEY MARIE GIESYNARNEY
yyg" cif Florida
COMMISSion#GG0998O1
r omm. Ex Ires May 1, 2021
o«, Bondedthra+9hNallo alMoaryAw.
REVI
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
;ev.
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notao Pudic- Statof Florida )
0 KARLEVMARIEGIESYVARNEY (Seal)
-NottrrhNic-i a ofFlorida
Commission N GG 099801
e f`� sm&dthrouoNo Mary Assn.
SUPERVISOR P Cf� LE MANGROVE
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