HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONOWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that na 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 Howie 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. rooms 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 proparty. 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
commencine work or recording; your Notice of Commencement. �, r
as Anent for Owner I Si&atdfe of
STATE OF FLORIDA �4 )
COUNTY of L U
The forgoing instrument was acknowledged before me
this L day of �/1 �"IUDr1►'? J�� 211� by
(Name of person acknowledging)
(Signature of otar ublic- State of Florida )
STATE OF FLORIDA
COUNTY OF__
<� Lust -e,
The forgoing instrument was acknowledged before me
this 3l day of 7J66-KJ 1 , zQ_ZZby
,1�4n-OA'n 0*_� ,
(Name of person acknowledging)
l c3i 2�
(Signature of Notary Public- State of Florida
Personally Known
OR Prod u id ification
Personally Known Oil Produced en ification
Type of identification
Type of Identification
1
Produced
:1�r ,. HASSINA 5ANABRIA
Produced
J CommiSSiOn No.
State of FioriCd
Cammissio� = GG 340327
�y 28, 2023
commission No-
HASSM SANABRIA
i � Nota(Seall State of Flonda
Bonded thr%gh Nat 'Ord, Notary Awl,
�� �}� : Commission = GG 340327
of tti° ` My Comm. Expires Jul 28, Y023
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
h
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 3438.2
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: 17 fl ,0 G'Alle
Le a1 Description: f r/lc qC 3`1 39041 / 6fIi
&6 , 60'4C
Property Tax I D #: —/�� + 5 Lot No.
Site Plan Name: L-Ct �- Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
amonai work
_Mechanical
Electric
rrormea un
Gas Tank
_ Plumbing
r tnis permit— CneCK all tnat apply:
Gas Piping _ Shutters _ Windows/Doors
Total Sq. Ft of Construction:
t�
Cost of Construction: $ ' / i�� cam,
Sprinklers — Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer —Septic
Building Height:
r
_ i
Name 4rv- d, Go-erc,dcdame:
' cliy- cozzcr,✓4--oK- ^
Address: le2 oilk
Company: 1�(Kcl, CCCLf C'r- (ymtx VM (`„c
-
City: State:I�C
Address: 160 cl cte� Va te, kJ
Zip Code. Lf ice% Fax:
City: FV✓t P _-�te_ State:z--c
Phone No. 0 3 3 � did
zip Code: a�cl Q- Fax: I )d-' cF(c �,Mi
E-Mail:
Phone No
Fill in fee simple Title Molder on next page ( if different
E-Mail, C�vi
State or Cou y License
from the Owner listed above)
It value of construction is 7500 or more, a RECORDED Notice Df Commencement is required.