HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPL&L )APPLICATION TO BE ACCEPTED
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Building Permit Application
SCANNED
P1 i Inning and Development Services BY
Building and Code Regulation Division
t. L u sde
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1558 Fax: (772) 462-1578- Commercial Residential
PERMIT APPLICATION FOR:
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IN,
Ad ess:' �e' \I-e-, A ex'Ge'� _X6
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Legi�1111 Description: A kns,_2? 7,
A-AS-ZIA-)
Pro)ertyTaxlD#:
Lot No.
Site !Plan Name: Block No.
Project Name:
SeTacks Front Back: Right Side: Left Side:
DETAILED
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Ad( Itional work to be pertormed under this permit - check all that apply:
Mechanical„ Gas Tank Gas -Piping Shutters Windows/Doors
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Plumbing. Sprinklers 8 Roof Pitch
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Utilities Sewer _Septic"T"It" Building Height:
Cos- of Construction: $ C VIC)
OWNER/LE=�StiSE
.CONTRACTOR:
NzHine K)IAA kiVXA_Q
Name.:
Companyb��=
Address: '2-7f)
Ac dress: i5A_1SNWSQA6-
cil rvjur.� � J(W" State:
Zia Code: 34483 Fax:
City: '-D I State:_
I II ne No. - / q /5.
Phi /q
'od;.7 1�44 q!A Fax:.
Zip C
E- ail:
Phone No 7 2- 25
E-MailA
Fil in fee simple Title Holder on next page if different
fr the Owner listed
State County License -Z
m above)
or
If value of construction is 2500 or more, a,RECORDED Notice of Commencement is required.
I
S R OR 1"AL C0
�TI4 Li N LAW I
URMAi[ ,
DESIGNER/ENGINEER:
Name:
Address:
City:=-
Zip: Phone
Not Applicable
State:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 1
City: V V State:
Zip: Phone:
iI
FEE SIMPLE TITLE HOLDER:
Name:
Address: AN
_ Not Applicable
iA
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
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 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 len er or an attorney before
commencing work or recording your,Notice of Commencement.
II
Signa r of Owner/ Lessee/Cont ctor as Agent for Owner
Itu"i4e o Co a or./License Holder
ST TE OF FLO IDA 1 )
STATE OF FLORIDA ))
COUNTY OF
COUNTYOF
The forgoing instr ment w s acknowledged before me
The forgoing instr Gent as acknowledged before me
this day of 20 j& by
this 0 day of 201B_ by
A VV&
rlN`
( a of person acknowledgin
Kimberlyo M. Garwood
•¢���':
(Name person cknowledging,.... ,�; m arW00
= Commission GG17542
,''�� Commission GG175422
?J January 16,12022
' Expires: January 16, 2622
'�-. '
,�. Expires:
q�• ��` Bonded thru Aaron jNotar
(Signature of NotaryyPu lic- Sfa on vu
(Signature of Notary Public- State of Florida )
Personally Known 1/ OR Produced Identification
Personally Known 1_ OR Produced Identification
Type of Identification
Type of Identification n
�O► ��
Produced
Produced 1
Commission No. (Seal)
Commission No. (Seal)
I.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
a
DATE
•COMPLETED
Rev. 7/2014