HomeMy WebLinkAboutrobertson back infill app.pdfAll APPLICABLE 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 Residentiai
PERMIT APPLICATION FOR:
PROPOSED -INPROVEMENT LOCATION:
Address: '� t)c _S c) �'g- Lccvt-,--
Legal Description: S" f Luce C 0_4 c_-n 5 P,
Property Tax ID #: 3 t2_1
Lot No.---�7—
Site Plan Name . .....
clock No. I
Project Name: 5J444
V_
Setbacks Front Back: Right Side: Left Side:
DETAILEb DESCRIPTION OF WORK.
CONSTRUCTION INFORMATION.
� CONSTRUCTION INFORMATION:
performed tinder this
—Mechanical — Gas Tank —Gas Piping Shutters
Windows/Doors
Electric — Plumbing Sprinklers Generator
Roof Pitch
Total Sq. Ft of Construction-, ';�L� — Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name _0nL o.L._t_ bar b7�- �15q
:dJ,:aS
Name: -f4i Lri u,' cz QCV�-c, V
N. C
Address:L
Company: Ki4eAC
City: �or ('_L1' Cl -e 5tate: F�
zip Code3 Kfr_,_L- Fax:
Phone No. 267 1590—
Addres5.
City: F—ov, t State:_L
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simpleTitle Holder on next page ( if different
from the Owner listed above)
E-Mail Vfyt(.,g CcekfC-v _1,c_e.
State or Coudy License —
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
$UoOLEMENTAL Get TRY.CTION MEN $... 0
Name:
Address:
City: ^ State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: - - Phone:
MORTGAGE COMPANY: � Not Applicable
Name:
Address: T
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 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 nor -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 3obsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement. 7 I
re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was , acknowledged before me
thisfi
day , +. . 20Z._7 by
(Name of person acknowledging)
(Signature of Notary P lic- State of FloriAot�rization validates
signature Only, '''' CC
��
Personally Known OR Produced ld�swa�oontent+�
Type of Identification
Produced , a
, HASSNA SAvA3
e_ c`^' Notary Public St fie a` =1ori
�P fir}c, Commi5jior = GC, 3-0327
Commission No. Z •� Fti`p ($���n'm' "'re' Ju 2&. 20
Banded lhrogh '.atior Notary A
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF s i L"I�+�
The forgoing instrument was acknowledged before me
this Z1 day of_-yaAeJ1 202Z by
paj rl-cI� cccr +C- r
(Name of person acknowledging)
3 z/�
(Signature of Notary P lic- State of Florida )Notarization validates
signature only,
toe
Known �C3R Produced ldengffin' gTert content
�r
oe of Identification L — — AZ! [,-Z— . dls
NASSAA SANABRIA
mission NO.'.� � � S missicr = GC,340327
c3�4 BorOeC through Na:iora, tio[ary As
5UPERVISREVIEWOR I REV EW VREVIEWON SEA REVIEW LE MEW WVE