HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONM1
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PLICABLI INFO MUST BE
IPLETED FOR APPLICATION TO BE ACCEPTED ,
Permit Number:
SCANNED RECEIVED
BY SEP 0 6 2910
mitDe
Building Permit Application Per
St. WdeCountyent
Pla "ning and Development Services
Bui ling and Code Regulation Division
23 0 Virginia Avenue, FortPierce FL 34982
Ph ne: (772)I462-1553 'Fax: (772) 462-1578
PEWIT APPLICATION FOR:
Address: ��
Legal Description:
/b
Commercial Residential V_
Pro p�rty Tax lb #: �c� 3 Q� ' �61d_ U0Q " % Lot No.
IIIIII I
Site Plan Name: / _ Block No.
Project Name:
Setl pcks Front Back: Right Side: _ Left Side:
Tota
ona
Ner►nn.—cncLN au LHOL apply.
lechanical _ Gas -Tank _ Gas Piping _ Shutters
lectric _k*umbing _ Sprinklers _ Generator
i. Ft of Construction:
Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic
_ Windows/Doors
— Roof
Building Height:
N�e Name r f>,Q�6'477
Ad ' ess: Company:
CRrState: � Address:
Zip'I1ICode Fax. / City: Jf% 1 i �L� �. Stater
Ph ,'he NZip Code:. y�%� �� Fax: 3-
i
E- fail: Phone No d
Fill: 'n fee si ple Title Holder on next page ( if different E-Mail 4 D de
l
above) State or County Licensee
fro the Owner listed
I,
If v Id'e of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: ,r �.�D
�iit,G/.+c�,�P r
Name:
Address: !
Address:
City:
State:,_1
City: State:
Zip:, / Phone_
7
Zip: Phone:'
FEE.SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: _Not Applicable
Name:
_
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone: I
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installatidr as indicated:
I certify that no work or installation has commenced prior to the issuance of a permit. � 1
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.
iI
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 our paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on th jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
rnmmnnrina wnrk nr rprnrdinE.vourAlotice of Commencement.
Signature o Owner/ Agent/ Lessee/Contractor
Signature of Contractor/License Holder I
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF v Lz L4_-2�
COUNTY OF
The f r oing instr ment as acknowledged efore me
by
The foFF oing instrument was acknowledged befor-6 me
this May of 4 20/S by
this day o 20A
-zy! ,
�I
(Name of erson acknowledging)
(Name of person acknowledging)
i
�
X
l
ignature of No lic- State of Florida)
nature of No blic- State of Florida)
Personally Known OR Produced. Identification
Personally Known '1fOR Produced Identification
Type of Identification
Type of Identification i
SHERRIFEHLMAN
Produced < Yau SHERRI FEHLW
o�• ec # GG
roduced _0MIal,_
•
87160 Commission # GG 187160
_ •' Commission
Commission:No. *
Q FJcpires March 14
\Spires March 14, 2022
mission No. o e
9 o�- BwAdThrusdgemotuyserAcm
. N9T o�c BondedfiN B�d9�N0
FOF f.�
s OF F�
5
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. I►'