HomeMy WebLinkAboutBuilding permit app All APPLICABLE INFO MUST BE COMPLET FOR APPLICATION TO BE ACCEPTED
Date: 1-7 4r,
cl �,G° PeZAppppica
8 ®®ST. LLl�mittinBuilding Permit
Planning and Development Services ®CT 11 2017
i
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: IV N i N '�U—V
Address: 69 05- 5, : 4kaN RW- or Gr+ Mrcer QL �AclsZ
Legal Description: Q C- l fl ���a' �0 DOO; • 000
L'9-r ail V^S�C'A Q Ce_ S IU(Seon P((?� b00k
Property Tax ID#: �1�((I- '�R)a' 9009-- 000 ' Lot No.
Site Plan Name:_ G tJ6'(\ RES 1&1Ce II Block No.
Project Name: n C 0A 0A L�s4 01t' On
Setbacks Front Back:�Right Side: Left-Side:
fir k lk t OJ 40q IA� rM I 1
-rcavx� n ailid wyh 02 At a c/ add
Additional wor to be perrormed under this permit-check all that apply:
_Mechanical _Gas,Tank _Gas Piping _Shutters _Windows/Doors
X Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq.Ft of Construction: d Sq. Ft.of First Floor:
Cost of Construction:$ 3c) d oU Utilities: _Sewer _Septic Building Height:
Name I- . A Name: . :: : ,C76'e)rrRiy f`14,LA XG
--
Address:~,. S .L (uvf Ff Company: l R 9
` ,(&CL PofCiy: le
Zip Code: 3L qQ_ Fax: 9(1v City: Par' a(Al-�vCke_ State: 1'L
Phone No. 77)`�53'COS-7- Zip Code: 3q%N Fax:
E-Mail: ?6a157 A a�d�, Cc�w Phone Nock 74a- ;-qq-�GG_s' crl 7-72-35:S.(Kjej
Fill in fee simple Title Holder on next page(if different E-Mail &90 k Pr�a a @ <ol, coc",
from the Owner listed above) State r county License CPC'0 s wSS�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: �C 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: V Not Applicable'
Name: C Mk- 9dxk0(\ Name:
Address: GQo5-S- T;,AkaA 9�tutr nr Address: -
City: fb,+ Piesck 1:C. City:
Zip: 3qa$a Phone: qs� - ),cQS- -sl05 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 priorto 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). tend to obtain financing, consult with lend r or an attorney before
commencing wjprkWr rdi r Notice of Commencement.
Signature of oVineff Less /Contractor as Agent for Owner Signature of Contracto License Holder
STATE OF FLORID , STATE OF FLORID
COUNTY OF ,� ,d . COUNTY OF 11-A I
The forgoing instrur ent was acknowledged before me The forgoing instr ent was acknowledged before me
this :day of 20�by this day of 20� by
CAP
(Name of person acknowledging) (Name of person acknowle ging)
ox�
(Si atur of otary Pu State of Florida) ig at of Nota blic-State of Florida)
-Personally Known '✓ OR Produced Identification Personally Known ' "�OR Produced Identification
Type of Identification Type of Identification
Produced_ oos`Y Pis GAYLE S BEYER Produced �,� `;;te�, GAYLE S BEYER
Commission#GG 104637 * * Commission#GG 10463
Commission No. Nf �t (gigot)s May 16,2021 Commission No. Q SeaI�xpires May 16,2021
AffEd� BondedThruBudgetNotaryServWs �taRF�� BondodThruBudgetNotery
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/203.4