HomeMy WebLinkAboutgarrason infill permit app.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
i
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Port Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentiai
PERMIT APPLICATION FOR:
PROPOSEi I PR V LOCATION.
f1rNT
Address: 2— 2 � �
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Legal Description:_L!�actLb l k / W
Property Tax ID #: l " =� Qdi1 Lot No.
t'�i �. Block No. 1 !S 4
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
�:ETAILED DESCRIPTION OF tiORK
0515
y „
21
Mona work to be pertormed un er t is permit —check all tat apply:
Mechanical Gas Tank —Gas Piping _ Shutters _ Windows/Doors
Electric Plumbing _ Sprinklers ! Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ C% O utilities: —Sewer —Septic Building Height:
1i�/NitE ES EI
.... ..: ... . . ..... .... _
CO# TAACTOR`;
Name CG �i d
e: '�G`�fii✓�
Company: vi CCL Via'" fg VM (,Vic
Address:
City: fi i State:
1
Address: c,-- 9J
Zip Code: % � '�-� Fax: A"
City: �v'� , � � Stater
_
Phone No. -
Zip Code: ` Fax: 7
E-Mail:
Phone No��(�
E-Mailtr%e-fr
Fill in fee simple Title Holder on next page (if different
State or CourAy License
from the Owner listed above)
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER. _
Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
city:
City:
Zip: Phone:
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 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
commencing work or recording your Notice of Commencement. _
Owner/
as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORIDA ICOUNTYOF
STATE OAF FLORIDA
COUNTYOF ,5 � C �'C.a -5 f Z (, £=r `L_
The forgoing instrument was acknowledged before me
this ,�3day of �Yl J24=(:A 20 Zz by
q T 6 CC(
{Name of person
HASSNA SANABRiA
Notrry Public - State of riari
Y :w:
Cnmmissior. = GG 344727
? ,t My Comm. zsatres Jul Z8, N
(Signature of Notary Public- Stske of FI�41
Personally Known _✓ OR Produced
Type of Identification
Produced
Commission No.
The f r oing instrument was acknowledged efore me
this day of _ 202by .
P
person acknowledgi of Nota ublic- State of F16rida) d1
Personally Known L� OR Produced Identification
Type of Identification e, (Q _, /
.yea HASSNA SANANiA
:�-,y��^ Notary Pub;it State or., rit�7
�eal) Corrmissior - GG 34G31 G
or 1.. My Comm.-_X:Xe$ t. 28, 023
800ded through ;atiora. aotary ssr.
J' /r yNASSnA 5atia3Rra
/
ission No. {S (7 V 3 - -`. ! )ubifc Sta: L. o` ='ori[
�;G Cammissior : GG 3st�JT7
My Comm. Exotres Ju. 23, 202
ary SS
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETER
Kev. 1/2014