HomeMy WebLinkAboutGLASS PERMIT APPAll APPLICA$LL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
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 APPLICATION FOR
Address:
Legal Description:
Property Tax ID #:
Lot No.
Site Plan Name: 5 ouno.G
- GS Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
3 i �
W V
X
Add,banal wor to ape orme under
this permit -check all that apply:
Mechanical Gas Tank
Gas Piping _ Shutters Windows/Doors
Electric _ Plumbing
_ Sprinklers ! Generator _ Roof Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ 0 d �-
"'- Utilities: —Sewer _ Septic Building Height:
d t
SS
Na::._.
Name. 4f * ,, 11
Name
Address: MovAjm r e
Company: VI G-' -moo- Wclit ilm r'✓ic
S te:
ZVI
Address: Q e
City: F�vf Stater
City: Pa r fi` 5 �` �-I! C '�
Zip Code: 3 J—,�- Fax:
""
Zip Code: 3 Fax:
Phone No. ,�I-L
i=-Mail:
Phone No
Fill in fee simple Title Holder on next,
page ( if different
F-Mail
from the Owner listed above)
State or Cou y License
If value of construction is 2500 or more, a
RECORDED Notice of Commencement
is required.
DESIGNS
Name:
City: `—
Zip:
FEE SIMPLE TITLE HOLDER:
Address:
City:
Zip:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:_
Address:
City:
Zip:
Name:
Address:
City:
zip:
COMPANY:
State:
—Not Applicable
OWNER/ NTRACTOR 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 Irlorida 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, cons t with lender or an attorney before
commeryefij'�g wolrk or recordingou1�, N (ice Commencemen .
Signature of Owner/ Lessee/Contractor asj Agent for Owner
STATE OF.FLORIDA
COUNTY OF
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The forgoing instrument was acknowledged before me
this I to day of �,c 4- 20 J by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known --_�
Type of identification
Produced
Commission No_
Of
STATE OF FLORIDA..a_
COUNTY OF � — �
The forgoing instrument was acknowledged before me
this I b� day of cAst 20 -11 by
C�f� -
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known `,� OR Produced identification
;Vvpe of Identification
:2o�-Eyey c _ CH RLOTTE M. WALTERS
mission # GG 92IMIJ
q� FP- Ex € S NQ�ember 24, 2023
Fo Fio: 8orui VFain€nsurance800,985-7n
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REVIEWS I
FRONT I ZON
COUNTER REVi
DATE
RECEIVED
DATE
COMPLETED
r. IRFt 1 B E R WALTERS
Commission G 9 1080
No. "= xpires P ov, 2023
Bonded Thru Troy Fain Insurance 800-3W7019
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