HomeMy WebLinkAboutPermit App, County, 02.26.2021All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _6 a—c;Ir QD1 1 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
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: t+v G► %P--7A", e- Od T. 4l d
PROPOSED IMPROVEMENT LOCATION:
Address: 6 96 1 l"EK TPr66 Q OE , Paf4 Sf Lucve , FC 3ggs-`;L
Property Tax ID #: `1 0" dW Lot No. .�
Site Plan Name: )v A S 44 — S ..3%s Block No.
Project Name: MOR-Tok Pnc-4- S-I- Li c te- AA%"' k tJb5,01+-A L.
Additional work to be performed under this permit —check all that apply:
Zivlechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Generator
Sq. Ft. of First Floor:
— Windows/Doors
Roof Pitch
Utilities: — Sewer _Septic Building Height:
OWNER/LESSEE:.
CONTRACTOR:
Name Cge_> Qj, 6 ( C.(
Name: J-i4(►MeS L, (A),41041 S'�
Address: 613 LAA J� aW g �>p 14tZ�
Company: W1 & c geab
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City: csf + P %e-LLe State: �L
Zip Code: Fax: ---'—
Phone No.. $S� � 1 OS�t S-
Address:o2a1 !U� ft n�b4 I& *s
!- /f✓ci
City: State: �-
zip code: ?, ((4 oo3 Fax:
Phone No 90SO
E-Mail ce
T
E-Mail: 0d%C%4_20.6
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License G4 G t $ l g4
/71
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,
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
flESICNERJENGiNEER: 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:
Address:
BOUNDING COMPANY: Not Applicable
Name:
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, 1 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 A
POSTED ON THE .JI® ITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OIN AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT_'
f Owner ssee/Con or as Agent for Owner
SignatrOF
� ature of t or/Li s er
STA FLORIDA/ -
STATE OF FLORIDA
COOF S7-Luc
COUNTYOF RT, L 0Ct(a
The forgoing instru aptvas acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20.,"t 1 by v
this4§ day of f;e-i Q(,A,0_qA.A 20j)AL by
wD 't LC„
ZM& L. (.J cam, S
16i�
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Name of person making statement.
Name of person making statement.
Personally Known Prod"t0ftrhif@dWG
Personally Known ® I� ---
Type of ldentificati 3i° e�'.Notary Public -State of Florida
Commission # GG 956362
Type of Identification ,,�"'�'� LIC.IA HIG
�=°�YPUB�- Notary Public -State of Florida
Produced
ofr�o.�` My mission Expires
Produced
_, ssion # GG 956362
February09, 2024
�,�„ e� Pliy Commission Expires
°;; �°` bruary 09, 2024
(Signature of Notary Public- State o orida)
(Signature of Notary Public- aM of Florida )
Commission No.r-tEI T yk3 b 02- (Seal)
Commission Nob 6 7 6_6 3 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/ 19