HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLEI
Date:
"OR APPLICATION TO BE ACCEPTED
Perm
RECEIVED jUL 17
Building Vermit
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
PERMIT APPLICATION FOR:
C) ag
p'*cation
Residential V/
Address:'
Zy
---C;-,:bI P'J'T'
Qc�z ic
Legal Description:
4- 1K8-!�J
* tZ 11 !3--s-
Property Tax ID #: a�3 �'" 1 O o"Z - GOG 4 O =1 Lot No.
Site Plan Name; (ALA-�) 0 j Block No.
Project Name:
Setbacks Fro
Back: Right Side: g (3` Left Side: to `
i._:'� I: f 1�. �(1��'i ,lii i, itiiil.F„��i.iGL _+a�
CO(ISTRUCTION INFORMATION �;15I
t -Y. iS -4
m:
�. , I ti , 1, l x
Additional work to bepertormed under tis permit -check all that apply:
_Mechanical _ Gas Tank _ GasPip'ing _ Shutters _Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:- Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
Name �1Z g`C✓til�v�� C,tk r- A bk)Y
Address: q 9 Z9l I�Qibt n-i IZ ,rcAc
City: 1� i c cc� Stater
Zip Code: 3�f i$I Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company�l F+�Y
Address: Z3�� ��Z I.-6-i-a-kOcc LJJ
City: (� t�'C State:
Zip Code: 3'Y9 8( Fax: 77 Z- �Q--03Z�
Phone No z- Z( se
E-Mail e mac- 5-,U�L ► nx.7
State or County License 1 3 z.') Z.93
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires.
DESIGNER/ENGINEER: Not Applicable
Name: �L--,i a.g-6 P 'vw�cav
Address: 1363c, -,s� -T. N Soso poi
City: State:_
Zip: S.'A o Phone ? Z� S-F Z - i 0c-0
FEE SIMPLE TITLEHOLDER:. _ Not Applicable-'
Name:
Address:
City:
Zip: Pho
MORTGAGE COMPANY: — Not'Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
IWIU;:R/ rr1NTRArTf)R AFFIDVIT! Annliraflnn is herebv made to obtain a Deemit 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 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 acd`essory uses to another rion-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impr�trsttions
our pro rty. A Notice ofiCommencement must be recorded and osted on the jobsite
befoPon. I u intend to obtain financing, consul ender ttorney before
rnm reI di Mu Notice of Commencem
Signature of O ner Les ee/Con actor as er
Signature of C tractor/Li nse older
STATE OF FLORIDA
COUNTY OF 'S �C' . 1, O c
STATE OF FLORID
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this � day of :1 o IN , 2011 by
this day of Jl V 2 by
0.1 V'N
(Name of person acknowledging
(Name of person acknowledging )
n
(Signature of Notary Publi State of Florida }
(Signature of Notary Publl - State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced ��.�.,, DEANNAMARIEGNENS
'•" MY CoMPdISS10N # GG 022U23
produced
,tom perARIE GIVENS
�"
:i°�
*' ES' December 16, 2020
Commission No. .r. a {�otaryPubvrunderwnlers
=?°' ' Y COMIJISS ON # G 022023
Commission No. 1- PIRES-De 6,2020
r o Bonde
'••, ;F „.•°
'%TFOF Bonded Thru Notary Public Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.