HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB -0 FOR APPLICATION TO BE ACCEPTED
INFFUST BE COMPLETE 07ti7
Date: i SGANNEOPermit Number: V Ll
REC#IM
T APR �14-ft
RECEIVED
Parmlitting Departm@nt
APR"2,4.
"NIffilfft Pe'rmit Application
Planning and Development Services Permitting Depa,
Building and Code Regulation Division St. Luct, r' -it
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:,(772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: I
Address:
Legal Description:
01 4q K-rt--5 b9.141'15 :F—%. PIS:P-65 F L- B44t 'a 7-
Pronertv Tax I D #: 'b 4 0 2- 6 0 9 C' 2-qI 0,1-& 0 1
Site Plan Name:
Project Name:
Setbacks Front Back:
C-1+ CXC 4'
Right Side: Left Side.:
Lot No. 4:5
Block No. 4S
Additional worKto be pertormed unciertnis permit- cneCK all triat appiy:
—Mechanical — GasTank Gas Piping Shutters- Windows/Doors
— Electric — Plumbing Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: S9
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
110WE NM @ I -R, T/5 Li
Name R tc,"NF, L. 4 mmvkoo-F, L A tvr�3 br.
Name:
Company:
Address: 6S01 KIP-TIZ ba-
City: V�, V1ke9-0-V- -State: VL�
Address:
Zip Code: S OA S 7- Fax:
City: State:
Phone No. 'Tt,9 4r-IS' '6 S 5-0
Zip Code: Fax:
E-Mail: rA teheAte
Phone No
E-Mail
Fill in fee simple Title Holder on next page if different
State or County License
from the Owner listed above)
if value of corittruction is 2500 or more, a RECORDED Notice of Commencement is required.
USE F. , P. I I I MIT 15 N,' N
MAM M. =0 I
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Nbme:
Name:—
Address:
Aciclress�
City: State:
Citly': 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 ermit holder to build the.subject structure
which is in conflict with any applicabI6 Home Owners!Assotiation rules, bylaws�or-angcov'en�hts�th,dt;may'rdst�ict or prohibit such
structure. Please consult with yQur Home Owners Associatio In 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,concurren�y,,rqview: room additions,
accessory . structures, swimming pools, fences, walls, signs, screen rooms and acces I sory uses to an'other n"on"-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.
7,
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Esi m-m ;� I
* ga�g6
Signa�ure of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The ' fc,Egc�ing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this —7.1day of rV'k- 20_Wby
this _ day of 20_ by
(Nanle of person acknowledging)
(Name of person acknowledging
(Signature of Notary POblic- State of Florida
(Signature of Notary Public- State of Florida
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification ..... MARIE GIVENS
Type of Identification
Produced L, V�z ....... NNA
M7 CoMrojSSION # GG 022023
Produced
IRE: Dec �ennber 16, 2020
Commission No. 1�� 23 otary pubrlr Unddirwdlers
Bond
Commission No. (Seal)
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SUPERVISOR
PLANS
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COMPLETED
iev. 712014