HomeMy WebLinkAboutquiles permit app page 1 and 2 for accordionsAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR:
"",. � P�1�FMf_N LOCAT110
Address: �a i C-1-C{{q
Legal Description: c 1(` iri;�`Z�' r G
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Property Tax EQ #: [ ' S Qi" Q�- ad - Lot No.
Block No-c�"'�_
Site Plan Name: c (Y--����-
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional wof 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: Sq. Ft. of First Floor:
Cost of Construction:.$ � �~� � Utilities: —Sewer _Septic Building Height:
�ONTI�ACTDI
Name
Name: Cf
Company: r I� C1 f
Address: ✓ i C G
Address: z/-2:� 4
City: �/ i ! E' cam- State: f—L
City: dJ� �. Stater
Zip Code: l< _--- fax: 7
Zip Code:Fax:
Phone No. �3
E-Mail:
_
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail Z
from the Owner listed above)
State or Couiz6License
If value of construction is 2500 or more, a RECORDED Notice of Commencement
is required.
DESIGNER/ENGINEER. � Not Applicable RTGAGE COMPANY. _Not Applica{aie
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.
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 your Notice of Commencement_ � .
of Owner/ Lessee/Contractor as -Agent for Owner
STATE OF FLORIDA�-
COUNTY OF
The forgoing instrument was acknowledged before me
this Zkl day of .C-t:rf-4,LLCL rq , 20-2,( by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification _
Produced ry CHRISTINA MARIE SALTOS
My COMMISSON #GG270307
Commission No. } 2_- v (SegAIRM-OCT23, 2022
3onded through 1 si State Insurance
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
COMPLETED
Signature of Contril'ctor//License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
� this 'i L�day of 20-4 by
�
(Name of person acknowledging)
ov W
(Signature of Notary.Public- State of Florida }
Personally Known OR Produced Identification
Type of Identification
Produced t�"P s CHRISTINA MARIE SALTOS
r: n MY COMMISSION #GG270307
Z ��J� � rWlRES: t}CT23, 2022
Commission NO_ ?„m 6 I rough 1st State Insurance
SUPERVISOR I PLANS VEGETATION I SERA TURTLE M EN/GROVE
REVIEW REVIEW REVIEW