HomeMy WebLinkAbouttuckman infill permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:3-1 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: I
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Building Permit Application
�VEMENT LOCATION:
. C-4 t of
Commercial
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Setbacks Front Back: Right Side: Left Side:
"aTAI�Ea DESCRIPTION O� �uOl��c: '
r
i CONSTRUCTION INFORMATION.
Additional worK to be per arme un er t is permit - check a t at app y:
Mechanical _ Gas Tank —Gas Piping — Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $�� ff Utilities: —Sewer —Septic
_T
OWN RAESSEE CONTRACTOR..
Name (54, Get--r �i6?1 Name:
Address: l �? E Company: C
City: t ! State: Address:
Zip Code: i��1 Fax: City: if -
Phone No. �"�J Zip Code:
E-Mail: Phone No �7
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or Cou y
IS
Residential
Lot No.
Block No.
Windows/Doors
Roof Pitch
Building Height:
State:_L_
Fax: '? -mod L
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License W
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Acid Tess:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: —Not Applicable
Name:
Name:
Address:
Address:
City:
Zip: Phone:
City:
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
commencing work or recordingyour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/Lice a Holder
STATE OF FLORIDA
COUNTY OF Lt-LCf-
STATE OF FLORIDA
COUNTY OF
The forgoing instrume t was acknowledged before me
this " day of 20 by
The forgoing instrurpent was acknowledged before me
this f i day of l'l GL yam= 20 by
cc
Panrci Q 1((KC1 'r+C'I(-
Pairc 'q LVIC4
(Name of acknowled g)
(Name of person acknowle ng)
C-44a- 1-1-12t
person
f
(Signature of Notary,.Pbbiic- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification a.
Type of Ide tification 1� Zo�
Produced Uir1-16
HASS'.A SANA
afar Public State
IJ]C� r Y
Commission No. Camrnlssiors aG
My Comm, EX.01re9 Jul28,
Snntl*C lhrt3u r3 hatltlnd!
Personally Known OR Produced Identification
Type of IdeQtification�
R A .✓�S`_°� '. HASSNA SAti
fl` rr - �°(� _ Notary PuoJc stag
�}ll SIQn Nfl:J �i� Z� s4 Eammission ;G
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2023 for '' my Comm. Expires
: to Assn. Bonded through Nabora+.
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REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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