HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COF.:: =TED FOR APPLICATION TO BE ACCEPTtl.
Date: 3 a - Permit Number:
RECEIVED
Building Permit ApplicationFEe o 3 2021
Planning and Development Services
Building and Code Regulation Division I Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982, St. Lucie c¢unty
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: r'
Address:
Legal Description: 3 iQ 3 S 0
L,e,5-5-/(1 l.S?f 1=4cfA,r1 Le
Property Tax ID #: �2 ;; 30 — a 33 "6:10 3003 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical _ Gas Tank _ Gas Piping _, Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 1 3 �� Sq. Ft. of First Floor: _
Cost of Construction: $ 0CIO Utilities: _ Sewer _Septic
_ Windows/Doors
_ Roof Pitch
Building Height:
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xVONTRACTOR��
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Namen rwo a H.T
Name: ce E�►'clC��V
Address: 3 f k-5' /Z
Company: _14(K cL C-ae-fer k(f/Imlx fkc
City:pie.-C-e— State: /7i
Address: 1603 kJ
Zip Code: Fax: /i/
City: Fc✓fi 0 State:
Phone No. 7� — � -'� 7� 5
Zip Code: ��l Fax:.'-?-) )-'Y66
E-Mail: /l/� -
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail V, P—Agl
from the Owner listed above)
State or CouAy License
If value of construction is 2500 or more, a RECORDED Notice of commencement is requirea.
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Sl��El�tTLH+iU�TR .
DESIGNER/ENGINE �
Name: '
Address: �� rr7 iVl �ryr�na �_L
City: F
zip: PhonP F72
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone: ---
BONDING COMPANY: —Not Applicable
Name:
Address:
City:
Zip: Phone:
/ 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 andcovenantsthat 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 ing work or recording your Notice of Commencement
for Owner
STATE OF FLORIDA
COUNTYOF
The forg ing instru ent was acknowledged before me
thise,day of 204 by
777—
G 2t CC6,/V UC
(Name of person ack_2_�
nowledging )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced CHRISTINA MAR" SALTO
lP?Y PUB
�_ MY COMMISSION #GG270
Commission No. 2� 030 ,�� . s EXPIRES: OCT23, 2022
nded,through 1st State In
REVIEWS FRONT kREVIEW
NING SUPERVISOR
COUNTER REVIEW
DATE RECEIVED_ 10 I
COMPLETED
ev. 772Zi3-,ir"
of Contractor,
STATE OF FLORIDA
COUNTYOF
The forgoing instru ent was acknowledged before me
this 2Y day of f 20 2 ( by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known 'l-/, OR Produced Identification
T�pe of Identification
CHRISTINA MARIE SALTOS
MY COMMISSION#GG270307
% � b � 0 /� S: OCT 23, 2022
Bo e t r o 1st State Insurance
REVIEW NS V E EWON I S REV EWLE I M EV EWVE