HomeMy WebLinkAboutGadway Permit appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
i
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 11 C2)—sn Iy
Legal Description: 1 L-0
�1)' tea' 3 Lot No.�
Property Tax lD f#: �� SQ�([���
(-oc)k !ce 00w)0-(1+ Block No. I
Site Plan Name: Cindtl��`�ynnnni__1�7.��I�
GGGGIIIE////(IIIIC.�d-
Project Name: � � a+ ti F Y )1ic
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
f'e—MOV� iSrino� C\ckt c oof olo Jn Ec, r
of�eCK
►rnstallk new CICL (oo f SyS m
CONSTRUCTION INFORMATION:
Additional wor to be]ertormecl under is perms —check all apply:
C�HVAC GasTank ❑Gas Piping
dows/Doors
n_Shutters
❑_ Electric 0 Plumbing ❑Sprinklers L J Generator
Roof FTI a Roof pitch
Total Sq. Ft of Construction:Ft
// 11 Sq. Ft, of First Floor:
E
Cost of Construction: $ `7 r o�nc _ Utilities: Septic
Building Height: 1 St OM1�
1
OWNER/LESSEE:
CONTRACTOR:
NameMICj)eP.I (1 c wCLcj
Name:
Company: OC
Address: Ica SIDE, hill
lc6ot CAIV-
City: State:
Address:
State:LL
Zip Code: �31lq S7 Fax:
City:
Phone No.. )c6- (oq 79,33
Zip Code: a
Fax:
E-Mail: kAtA (e_C GXe-;S Q\ JQIrY)G CG84
Phone No. . g
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE COMPANY: I _j_/NotApplicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ZNot Applicable I BONDING COMPANY:
Address:
City:
Zip: Phone:
Address:
Zip:
Phone:
Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the ork ano instanatlon as molcatea.
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 ermit holde to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anfcovenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed or any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respe s, 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 aid posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender o r an attorney before
rk or recordin our Notice of Commencement.
commencln wo
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Signature Owner/ Lessee/Contractor as Agent for Owner
Signature of Q ntractor/Licen
a Holder
STATE OF FLORIDA
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STATE OF/FLORIDA p�
2
COUNTY OF L.LACAe
COUNTY OF �7T
The f oing instrument was acknowledged before me
The for oing instrument was
day pt
cknowledged before me
20� by
this day of Apci j 201 6y
this of
V>n uSS
cv)n
LIS
Name of person making statement
Name of person gO
ng statement
Personally Known LL/OR Produced Identification
Personally Known 01
Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signatur of Notary Public- St
ature of otaryu lic-
ate of Florida )
NOWV Public Stall of Fla
Commission No. MosB
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Co fission No.
�yp Public state of FICH
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Cpnm w GG 308
Eapma 0310712023
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_ my Commo610n GG 3089
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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