HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONw
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All APPLICABLE INFO MUST BE COMPLEYr-u FOR APPLICATION TO BE ACCEPTED
Date: L \yt 1 Permit Number: \ $cs y O 53(�3
Planning and DevelopmentServices
Building and Code Reguldtion Division I
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: n
Address:
Legal Description:
Property Tax ID #: I ?SQN - 6OL4 ' C�
Site Plan Name:
Project Name:
Setbacks Front Back:
e
SGANW-D
BY RECrEIM
lqt i Q trio f'nylnlh A P R k ` 18
Building Permit Applica ion
ST. Lucie County, Permitting
Commercial Residential .
Left Side:
Additional work to be pertormed under this p',ermit — cnecK all that apply:
_Mechanical _ Gas Tank I, Gas'Piping _ Shutters
_ Electric _ Plumbing — Sprinklers _ Generator
Total Sq. Ft of Construction:--
Cost of Construction: $ A 4 oco
Sq. Ft. of First Floor:
Lot No._
Block No.
Windows/Doors
i/ Roof S Pitch
Utilities: —Sewer _Septic Building Height:
Name C-V'C-,5,A (-v-� v r✓�"1
Address: 5505 F4 }�'e�c a . f✓�Q
City: Fi State: (
Zip Code: Fax:
Phone No. `-l►-1- q(iS - 1-139
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: '1<Z6)A✓& i-),If
Company:1Z�11�� ICoa�•ncn
Address: (9`13 -SL-) Gk-.�LP- S4
City: CF-( Sri iuc-".e, Stater
Zip Code: 3'1- 1 Fax:
Phone No )ia- dleo -gi ls 67K-
E-MailY�1��� Qoc��nC@ ual+ob
State or County License
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEI I,ENTAL CC?NSi'RUC7rl@ i.A' I
FQ 11�ATIO:N•
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: _Not Applicable
Name:
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.
Q,X -
Signature of Owner/ Lessee/ ntractor as Agent for Owner
W_0� kLg,
Signature of Contractor/Lic ns Holder
STATE OF FLCI I!r
STATE OF FLORIDA
COUNTY OF
COUNTY OF -9 fit-., Lv e. �e
The forgoing instrument was acknowledge before me
NA
The {or oing instrument was acknowledged before me
this%'q day ofq A �i 20 by
this day of S� A t' 20)1 by
(Name of person acknowledge g)
(Name of person acknowledgin )
(Signature of Notary Pu c- State of Florida)
(Signature of Notary blic- State of Florida )
Personally Known OR Produced Identification
Type of Identifi tion
Produced �- p I►. ®-
Personally Known OR Produced I�dt� ationwt
Type of Identifi )M_---
roduced 1,4 i )EANNp.MAR►EGIVENs
# GG 072023
as � S
RIE GIVEN,
t 4r ��� •• DEANNANIA GG 022023
Commission No. ��� °' `O: ($`����MISSION#
• ........ee�r�N
cq 2020
�^ =*� T •'�` EXPIRES: December, 16,
commission No. 'edThrUNotzn'NMd'derwriter'
;r.' EXPIRES: December 16, �02�
`r r Notary Public Underx�ite
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REVIEWS
FRONT
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ZONING
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014