HomeMy WebLinkAboutBuilding Permit Application AN APPUCASU INFO MUST BE CC%WUlED FOR APPllCATlC2N1 M BE ACCEPTED
Date C
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Building Permit Application
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= carft9woeon Divisiop Comm rcia( ;:
Avenue,Fort A& Ft 34M
n'TIE 7 2)4fi2-1553 Farr:M2)452-1575
PERMIT APPLICATION FOR: Re RMf
LPROPOSED IMPROVEMENT LOCATION:
Address: S9 3 Si set&W , F-W Rerce R.34982
Properly Tax ID� 3402A09-04784000-3 Lc' ti z. 40
Site Plan Name:WA Block N�a- 64
Project Name: 5903
DETAILED DESCRIPTION OF WORK:
we na! _s _-:�GUM-9 ASDW SN-%W and tr-fir,uc -z Aeo ROO&V Lwar-to rw ON=3sck oe Ed-*a of ter W31V JK-k W nee
arm"code we as ram a seN-at3"�e � I%*=a-drior-y-*m w r*rain v d ane a se lr4Li-esw-ase romav-w%are me im�-x* ow
-*Cassa-k mnrrvs iisa-1 W ft run^.-*use a-Q a 984&05"':Jw wit`W-%W Ta%fib'r-'?-we W UK':o
New Uectrca! Meter N'A Sew Electrical Mere,N?A
CONSTRUCTION INFORMATION.
Additional wwt to be gerfbrn*d under this permit-chea ail that appls:
_Mechanical _Gas Tank _Gas Pip ng `Shutters _Windy�prs Pond
_Electric —Piurribing Sprinklers _Generator _Roof phrh
Total Sq.Ft of Ca ntructiow 32.45 Mw;6 Rat Sq-Ft.of First Floor: WA
Cost of Construction: S 16.850 00 Utilities- —�'ea.e. _Se.ti.c Bu Fd:ng Height;
OWN ER/LESSEE: CONTRACTOR:
Name Catnefm MAer Name: CIVISKOW Co&ns ----
Address: 5903 Sunset Blvd Compaw'Cams RoDf N tnc-
Gry- Fort Pierce FL State.— Address: PO SON 1-1*7
Zip Code:34982 Fan: NlA City Fart Perm State: FL
Phone No.N/A ! Zip Cade:3*79 Fax: N'A
E-Mail:NIA Phone No 941-%0
FIN in fee simple Title Holder on next page(if different E-Mail corn
from the Dwner listed above) State orCouary Ucense Ccc-essoll
ff value of construction is 25W or more,a RECORDED Notke of Co a movement is requWad,
If value of HAVC is$7,5W or more,a RECORDED Notice of Carrommmmnentis requkv&
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ti Not Applicable MORTGAGE COMPANY: —Not Applicable
Name: Name:
Address: Address:
City_ State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x 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.
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 str ures, 5 'mm�poo}r,-fences,walls,signs,screen rooms and accessoryuses to a t -residential use
WARN G TO 0�:Your failure t�Record a Notice of Commentement ma suit n paying twi for
i proem s to your propertylA Notice of Commence 'ent must record In the publ records of St.
ucie Co xy'and S,t on the jobsite before the firs nspectio in a Lain financing, consult
with I r or t me before commencingwork r recor t o omme e men t.
j/ .
er/L e/Contractor as Agent for Owner ntract ense Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF u COUNTY OF
Sw yn to(or affirmed)and subscribed before me of Swgm to(or affirmed)and subscribed before me of
d yslcal Pre ce or Online Not rization t ysical Pre e r Online Not rization
this�day of t l�— 20by this day of 20)/by
� ��
Name of p r on making statement. Name of pers n making statement.
Personally Known y OR Produced Identification Personally Know 1Nficati
Type of Identification Type of Identific ion ��I,�_SIBIeofRonca
N•• ,,;- BELINDADARDEN ty lary
Prod ed ywia x-state oI nonca Pro f� !`i�. rrnmias�on K GG 169825
C xnM"'V p GG tS9r?25 My Comm xp-r ec 1B,2021
•3, T. My Comm EepresDec 18 202^ �tlinm.l ra r,rvnaywv
(signature c Notary (Signature of Notary Public-State of Florida I
Commission No. (Sear Commission No. (Sear
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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COMPLETED
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