HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1�1a"1 1'� Permit Number: 1-111� d�0a
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F- Building Permit Application NOU 2 7-261]
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 Residential
PERMIT APPLICATION FOR: rye h C e—
PROPOSED INPROVEMf°NT, LOCATION. ,
Address:��b� b�K�� . PT/%K e—�L `7�J �7
Legal Description: f13 35 32 A/ 26-Y FT DF 4 112 of S' F- 1,6FN!✓ 04 6F /11A f.�-/-z.8 CS
,5- 30 9TAM.-SFLII-Sr FT 69Al 2Ae-0ASSAGDP 49 A .0 E CPAJ APYA4 0FA/9 �4
Property Tax ID #: W,3 13--� QQQ --'> Lot No.,
Site Plan Name: -0—Q'U A,67-' Block No.
Project Name: 604,gM %
Setbacks Front Back: Right Side: Left Side:
CC►NSTRUCTION INfORMATION
Additional work to Ue--p-e-rFo-r-m—ea under this permit- check , a !hat appy:
_Mechanical —Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: AV, Sq. Ft. of First Floor:
Cost of Construction: $ ,e:�2 DAD Utilities: —Sewer _Septic Building Height:
Pitch
OWNER/LESSEE
CONTRACTOR:`
Name ftin: #Aa rAA1 w7-
Name: D
Address: Q,s49a-"AIrLY,% /20 �q6
Company:
City: d P#/LT Pign l e,' State: 04L
Address:
Zip Code: Rq4 Y7 Fax:
City: State:
Phone No. 47%2--Z (#.t0-t--)1-,9
Zip Code: Fax:
E-Mail:PQLe-1'd 6J6 C,O, QtjA f.4 e--t
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CO:NSTR'.UCTION UEN`lAW INFORMATION
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name: *A/rM&wfV �D.�t
!3o-l4NtY.6- hFdkSL EWA
Name:
Address: AIVIT, <S
CG/9- Gym
Address:
city: rORY #41&zek
I State: L,
City:
State:
Zippy q y6 Phone
77A - yo 1 7ho 3
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
I
Address:
City:
I
City:
Zip: Phone:
I
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 coven a nts.that may'restrict`or prohibit such
structure. Please consult with your HomeOwnersAssociation and review your deed for any restrictions which may apply.
. 2.
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, ti e;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' hon-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
commenWflg work or recording your Notice of Commencement.
wneriP Lessee/%6ntractor as Agent Tor uwner
STATE OF FLORIDA
COUNTY OF '5k , ty o
The forgoing instrument was ackn
this 'WN day of 0 0,3
1A1%A'�\oM:� Go,n
Name of person making state
Personally Known
Type of Identific,Ation
Produced C O
f
(Signature of Notary Pu c
Commission No.
dged before me
2011 by
OR Produced Identification
of Florid
-� pMAR1EGiVENs023
oMj C�� bet�16,2020
F�p1REScsotan publicUnO�
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of . 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. " (Seal)' '
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ING
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COU ER
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DATE
RECEIVED
J
a&i
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DATE
COMPLETED
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Kev.25/L/1/ I 1 1( I