HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: OSQ Q
SEP 2:�
Building Permit Application pe`5t��tiec��nrl
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address: 4-422 Al AX)y MA. 7 oAT •P *zcF • Ft� 3 4 -7
Property Tax ID #: Lot No: 3
Site Plan Name: Block No.
Project Name:
Additional work to b"e performed under this permit - check all that apply:
_Mechanical _ Gas -Tank _ Gas Piping —Shutters.
Electric _Plumbing ='Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of.Co ctio $ �S J��O (-. 00 Utilities: _ Sewer . _Septic
Name V����/ilp�l'%®� G
Address: TY,' 7D' • .-Ar_ (: 1 5`_f2 `BSI.
City:h/�/,,
Zip Code: �i �{ Fax 'I ' °„ 1
Phone No.
E-Mail: Yor ena (0 9 oi,)®,Mg4 , 4!9m
Fill in fee simple Title Holder on next page ( if different .
from the Owner listed above)
Windows/Doors.
Roof Pjtch
Building Height:
Company: •-: *V-
Address ` + '�3�b ` cpki�3• �'% .
City: " /I/LfA "uState:�L
.. . / , Fax: Zip Code: 3!: � D
Phone No 1�� C31/ '�3 56
E-Mail
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of 'Commencement is required.
ENGINEER:
7AAddress,
_ Not'Applicable
MORTGAGE COMPANY: !
_ Not Applicable
Name:
.
Address:
City:
State:
City:
State:
Zip:' Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
NotApj'llcble
BONDING COMPANY:
_Not Applicable
Name:
Name
Address:
Address'
City:
City
Zip: Phone:
T
Zlp,r : Ph'one
',•
.- -
OWNER/ CONTRACTOR AFFIDAVIT: Applicat bn r' h retly 4t ade to,obtam a''perri�it to do the`work`and installation'as indicated.
I certify that•no work or installation has corrimericetl prior+to the`.isSuatlCe of a pp'mit' }
St. Lucie County makes no representation that is gcahtirig a.permrttwyill aUttion2e the perriit'1iolrto+build the subject structure
which is in conflict with any applicable Home-pwners As ocration'rules, byiayvs Ca' covenantsrifig -i rjaysrestrtct: r p obrb}t such
structure. Please consult with your Home Owners,Ass, a.tion and're ieiw> oUr— for a:r�y res. njal bns WIth rrray ap"N
In consideration of the granting of this requested permrtrl(dn hlereby are`#hat l;innll, m a',11 resliects,'erfoim•.the wdrk.',
in accordance with the approved plans, .th"o F1'otida>Buildirag Codes and S#.'Lucre County Amendments r
The following building permit applications are 16xqrnOt fro► uhdoY� othg a GI1"Cnncurreney° e�rev�rl raoriit ddI igns, `
accessorystructures, swimming pools, fences, wa11%, -signs) 'screen rooms and accessory Vises foresidential' use
x ,
"YIrARNING TO OWNER: YOUR FAILURE T6 lafECDhb A `NOTICE OF COIY�MCII�IT;M'Y�C'JLT'{IN+YOUR PAYING
TWICE FOR' IMPROVEMENTS TO 1fOU�t V OPgRTY + A NOTICE `O(F C011�1 1 NCEMENT rNU BE "RECORDED AND
POSTED.ON THE JOB SITE BEFO�22C Twr;xE1R' I)�1$PECTION+, iE;11O1�'1111��IJq TO OBTAl11Y'111)ANCING, CONSULT
WITH YOUR LENDER OR AN`WrrCi iNRY BF(� R ' IE{ [II1��YN� ?.lf�lii tilyl[tT� E i�F [AMMIF MFNT"
Signature of Pnert/`Lesse !CQntractbr'as,Agent for Owner
Jcense Holder
STATE bF�� 1:0111I
COCiNTY'O l%t,,
St�11` " ORIDA�''
CO(111�F`i(,
The f orng (n�sthb'rri k t �s ackn'owled ged efore me
this dayo ' 20by.
The,forgoing-iristrument'was;acknowledged-.before,me
by
x
„this."Qd'ay'of .20�
1
�1. •\ .l��V 1 �lLi`� l
;Nape o ,p`e`rson makrrig s at " nt.
Name.of person making statement.
Iersonally Known OR Produced Identification
Personally Known `r .. O:R Prod;uce Identification
TXpe of Identification
Type.of Identiica"tro� -'
Produced .'
Pr'oduced
(Sena LE'A9ffflidj
°`� °O��s{ate of Florida-NotaryPubCo
Commi u�Commission # GG 2700�)
(S gn otary2Q'' at of F19d� D8'IiSBy
_ Commission # GG121936
fissionNo. ;, Expiregs5�
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(27 2021
:� on Expire
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�%x"�,8 ��� Bonded fh('u hr% Notary.
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01" r : y o
n} , October 22, 2022 „
REVIEWS
FRONT
ZONING-
SUPERVISOR
P,LANS,,.
VEGETATION
SEATURTLE .`MANGROVE
COUNTER. .
. REVIEW;
` REVIEW,
REVIEW.
REVIEW
REVIEW REVIEW
DATE,
��.
RECEIVED
DATE
COMPLETED
Mev. /-/i/ly
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