HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALLAPPUCABLE INFO MUST BE CONII&MD FOR APPLICATION TO BE ACCEPTED
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SCANNED
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Building Permit Application Lucie ®unfiED
Plan ing and DevelopmentServices
eufM' and Code RegionDhWon AUG TPIDI7
13OD„ rginiaAvenue, Fort Pierre FL 34WZ-
Pho I : (772j 462-1553 Fax: (772) 462-1571, Permttti Department
Commercial Residential s Wde county
PERIdi1IT APPLICATION FOR: TO Select from d
r°Pa°x, click arrow at the end of fine
PRQP SED'tiVIPRQVEMENT 1-4CATION
22 37 40 THAT PART OF GOVT LOT 3-LESS TO SFWMD I
Legal 04 ptlon::^ FOR C23- DESIGNATED AS TRACT'D' AS SHOWNIN PB'
25-38B AND BEING NOT A PART OF THE PLAT (SUBJ TO i
ESMT TO C ANDSFFCD) (1.29 AC) (OR 4111-1325)
Prope II Tax ID #• a - / - - - — -- -
Site P� I Naine: Lot No.
Block No. _;____•
Sethack Front / 0 _ Back: Right Side: O
F
-- �Lett Side: � d
'DET-1,ED,r t,
'hESCRIP`TIOrN `
�F WORK
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SEE 0 FF ZXJST�y u.'e 4AS �, e.. X . 15
SON `ilCTfdN4iNFURMATtON-
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workape , .. under
is permit c a app y:
as�ank Gas Piping
Z p g — Shutters — Windows/Doors
EI c _ Plumbing Sprinklers , — Generator _ Roof
Roof pitdi-
Totai Sq. of Construction: Sq. Ft. of Fist Floor;
Cost of Co .� ction: $ UliGties:
— _ Sewer _ Septic Building Height:
R•
Nam
Name: N
Address:) 1 Company: J�%l
To
�: tf 1 State: Address:
Tip Cook; Fax w w
5 v: eiTi� State:
Phone No. Tip code: �19 90
E-Mail: Fax:
• Phone No. b
Fiq In fee ple Title Holder on next page. (if different E Mail: ,,1e,
Frain the
listed above) State or County License: - OS S9 t/ = 377i►T
f value of C i a �• 'om is $2500 or more, a RECORDED Notice of Commencement is required. .
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DESI NER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name.
Addr ass: Address:
City: I. State: City: State:
Zip: Phone: Zip: Phone:
FEES VIPLE TITLE FOLDER: Not Applicable- BONDING COMPANY: Not Applicable
Nam ., Name:
Add r ass: Address:
City: City,
Zip: I Phone: Zip: Phone:
I I
OWN R/ CONTRACTOR AFFIDVIT.' Application Is hereby made to obtain it permit to do the work and installation as indicated.
I.certi that no work or installation;has commenced prio? to the issuance of a permit.
St. Luci County, makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
stfuctul e. 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 accol dance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The foll (wing building.permit applications are exempt from undergoing a full concurrency review. Poom additions,
accesso 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
impro ements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before lthe first inspection. If you intend to obtain financing, consult with lender or an attorney before
commiLncing work or recordingyour Notice of Commencement.
STATE OF FLORIDA STATE OF FLORIPA
COON Y OF ' C1A- �2.. COUNTY OF ; - t Y'�►e.
The forg" ing instrument was acknowledge before me
this i day of 20 Y by
(Name o persorf acknowledging)
(Signatu a of Not ryPubllc Ste of Florda
v)
PersonalKnown /� OR Produced Identification
Type of Identification Produced
The forgoing instrument was acknowledgedhefore me
this•_U day of A- 20 by
�C�[llfll C �, )1k�2 r51r�11
(Name of person a knowledging )
(Signature of tary P blic State of Florida)
Personally Known X OR Produced Identification
Type of Identification Produced
'C +++�!;o1o;�(�ITTANY REDDI
No. "� ` �_ of Florida -Notary P mission No.
*®'6 Commission # GG 190 82
,�tSIOTTANY REDDIN
ate of Florida -Notary Put
Commission # GG 19028
nm• eDruary zu, zuzj � IR Fe ruary 26, 2022.
FRONT NS VEGETATION
COUNTER REVIEW REVIEW REVIEW . REVIEW- REVIEW REVIEW
RECEIVED I I I I I I 4
P
DATE- --------- T
COMPL I D '
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