HomeMy WebLinkAboutgreen infill permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Q I n ick -
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:
Permit Number:
Building Permit Application
Commercial. Residential
Address: ,FJ e✓Juuf f %,-
Legal Description: I:4 ft'�
Property Fax iD #: =
Site Plan Name: ...
Project Name:
Cd rl
Setbacks Front Back: Right
C o V1C' -C_4C_ r YV
Left Side:
Lot No.
Block No.
Mechanical Gas Tank _ Gas Piping Shutters _ Windows/Doors
Electric _ Plumbing ^ Sprinklers — Generator — Roof Pitch
Total 5q. Ft of Construction: 02
Cost of Construction: $ �9, 3
Sq. Ft. of First Floor:
Utilities:
Name +e F-X--
Address: $ lark �L� �,&_atf
City: it State: lr--L
Zip Code: Fax: /l/Ij-__
Phone No._7
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Sewer _ Septic
Name:
Building Height: S--/
V
Company: K i vx 4 Cc,fir" , - wx ilm f;44_
Address: U le f1d _
City- f State:�_
Zip Code: 3 Y Fax: ��src6 M1 Z
Phone No 7?)-9,� 6,—
E-Mail �' L C:ce �!
State or Cou y License
If value of construction is 2500 or more, a RECORDED !Notice of Commencement is required.
NERANGINEER: Not
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER. Not Applicable
Name:
Address-
City -
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
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 Nome 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 wi[I, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes -and 5t. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrenry 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
k din our Notice of Commencement.
commencing won or recur
of
as Agent for owner
STATE OF FLORIDA C�--�
COUNTY OFF�_�7"
The for oing instrument was acknowledged before me
this day off 2_(3Z. by
PC4-VI d.
(Name of person acknowledging)
(Signature of Nota ublic- State of Florida
i�izattora validates
Personally Known► i� OR Produced
d f t9
Type of identification l z2
Produceontent—
d :i HASSNA SAhABRIA
��` Not Pu is State Of *,pride
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commission No. Z �o; C�or : GG 340327
of mow. My Eorrrr, Exatrt,5 Jtr, 28. 2423
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REVIEWS I FRONT I ZONING
COUNTER J REVIEW
DATE
RECEIVED
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Signature of Cantractar/License Holder
STATE OF FLORIDA �' I LU c e
COUNTY
The forgoing instfent was acknowledged before me
this clay off 0Y1U a!24 20 2 by '.
Po A, P 1,4 0
(Name of person acknowledging) -
(signature of Notary Public- State of'16'IALtion validates
pnly,
Personally Known �''—DR i���l
tgNe,^t—
Type of Identification I / Q /Z -Z-
HASSNA SANABRIA
Cpmmi55ion No. - �` �
Notary( l ljState 3or
27
Corn n1 issiar' - GG 340327
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Mr ccrrr:. EXPV 5,A'r 28, 2023
Ih,,.,oh Natinca. Notary Assn,
EA
5UPEREV EWOR REVIEW V REVIEWDN 1 $ REVIEW TURTLE MEVIEV1fV£
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