HomeMy WebLinkAboutLot 30 Permit application 9.13.2021ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
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F L O R 1 D A
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 0 � O�
Legal Description: �-7
IN
Property Tax ID #:Of � - 0�pj- (�v31 -�� Lot No. L/
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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Additional work to be Dertormed under this permit — check all apply:
nHVAC1:1 Gas Tank Gas Piping _ Shutters Windows/Doors
❑ Electric ❑ Plumbing Sprinklers ❑ Generator Roof
Total Sq. Ft of Construction: Scl. Ft. of First Floor:
Cost of Construction: $ Utilities: L/0 Sewer D Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address:_ (
City: Hljehl4Lo (i'YYI C( "State: _
Zip Code:3 Fax:
Phone No.
Company: '
Address:
City:
Zip Code: ;���1/ Fax:
Phone No. o&/-'97--�160
State:
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E-Mail:'ZP# �0 Q-t(Y141 VP R/�) S /y .
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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E-Mail: !'/% 4A) 0 /i IPI /llxCe
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State or County License: Mg.
If value of construction is 52500 or more, a RECORDED Notice of Commencement is requirea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City: �(
Zip: Phoi
Nqt Applicable
State
FEE SIMPLE TITLE yOLDER: _ Not Applicable
Name:/.�
Address:
City:
Zip: Phone:
MORTGAGE COMPI_ Not Applicable
Name: ��//
Address:
City: State:
Zip: Phone:
BONDING COMPANY- _Not Applicable
Name:
Address:
City:
Zip: Phone:
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
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—'Signature of Owner/ Lessee/Agent
STATE OF FLORIDA /�
COUNTY OF 9�
The f going instr n sac ]edge efore me
this day of 20 �by
(Name of person ackn wledging )
(Signature of No r PUFC- State of Florida )
Personally Known `�4R Prodifif�4iJQ W
Type of Identifica ' :P um dMYCOMMISSIM
-;,F'� oP"•; CAMNES: July 27, 2025
''•Op `` •'' Bonded 7hru No
Commission No. t#nderwdters
Aev1SCQ V//1J/GV1'1
s
Si nature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The fo going i tr ent was f�cknowledged before me
this day o CCvI 20 24 by
(Na a of person ackno ledging )
(Signature of Notary Pub I If State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
.��Hv p,•FRA
Commission No. MY CO MfSSIOl iONZAHH 11471
EXPIRES: July 27, 2026
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