HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
i
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: -
........... ..
Address: V(n.
Legal Description: S44vi (-5k L c �ry
Property Tax iD#: Lot No. ______�
Site Plan Name: t ., h LCz F�li Block No.
Project Name: -c t rr
Setbacks Front Back: Right Side: Left Side:
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M
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4 TI � OFF -A'T
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Additional worK to be perfo
rmed
p under this permit-c ec a t at app y:
Mechanical Gas Tank —Gas Piping Shutters Windows/Doors
_Electric _Plumbing } _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: , & Sq. Ft. of First Floor:
J
Cost of Construction: $—d '4'o o '� Utilities: _Sewer _Septic Building Height: Q
O �EREf GOTtACTOR tr
Name YV1 "�� Name: ' c" �C v 4 c�I/
Address: Company: tits` {'bt/ L' f`✓i4
City: c c=-C' State: Address: U c
Zip Code: Fax:_/-V City: State:1--'L
Phone No. � J�'�� l� __ Zip Code: �l Fax: -%66 `FVY
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail , Clfv'flefi M l- '
from the Owner listed above) State or Cou y License
1f value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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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: TNot 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
comme_qcing work or recordin our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Conti AA&or/License Holder
STATE OF FLORIDAq STATE OF FLORIDA
COUNTY OF �-uC i = COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instr ent was acknowledged before me
this?-fLA day of t z0� tGdayof - JL L 20-4 by
(Name of person acknowledging) (Name of person acknowledging}
(Signature of Notary Public-State of Florida (Signature of Notary.Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification _ Type of Identification CHRISTINA MARIE SALTOS
Produced I Produced 1�Yam MY GOMMISSION#GG270307
_. , CHRIS 11NA MAME SALTOS _,-
_' e�1 PAY COMMISSION#GG270307 I @?(�{RE is OCT 23,2022
Commission No_ L-, � F`(Se9#RES:`OCT23,2022 Commission No`� �� ee RArougtt 1st state Insurance
MVSonded through 1st State insurance
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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