HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI-7o6
All APF
Date:
INFO MUST BE COMPLEYc6'FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit Appli
Plannin and Development Services
Buildin � and Code Regulation Division
2300 Vi7�1
inia Avenue, Fort Pierce FL 34982
Phone772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR:
Address
Legal De
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4
V,
ti 20163EP 2
Residential —
6 �gz&59bi -l(0Ir
Propert) i Tax ID #: \ cz) ® ®,a's " L"i-f,)O «V Lot No.35
Site Pla Name: \ .�Q �6 SV,WCie COU1ftt� Block No.
Project ame:
Setbacl s Front Back: Right Side: Left Side:
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Pipingal work to be performed -under this permit - check aWthat apply:
chanical Gas Tank Gas
ctric Plumbing Sprinklers • •
Ft of Construction: 'Sq. Ft. of First Floor:
onstruction: $ -7)*7 Utilities: —Sewer —Septic Building Height:
Name1\ ► �v�O �,;- Name:;�C3`�Y�., \ ;.'. {!R��Ptt4s
Address
City:` ,:Q` �„ :`E$CGt� State: 1, Add'ress• 1���1'..
Zip C �de:5'-k 9 9 Vl�u Fax: City: GK State: C---
Phon No.1 Zip Code: Fax:
E-Mai I �_ 1°tUliZ1�. � QV-t-en 11;�st° .nt Phone No °7 c�, .fie
Fill in „ee simple Title Holder on next page (if different E-Mail Wk 11 bz�'W'r-) � \ 0w i
from f he Owner listed above) I State or County License ;Z ?3 3
if value bf construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:_ _ Not Applicable MORTGAGE COMPANY: — Not Applicable
Name:-,..- 19A Name: h11 I
Address:" Address: !
City: State: City: Stater
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
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 Si. 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 t'o 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
rr%mmnnrina xe,nrlr r%r rarnrclina vnur Nntire of Commencement.
fA d
Sigrrat re oOwe ./Ce a/.,Contractor-as-Agent,for-Owner
�Signa eur -o -on ractor/LieenHo der,,
STATE OF FLORIPAI
Q
STATE OF FLORIDA N
COUNTY OF II��liln �1\fw
COUNTY OF I h(11'. m I�w
The f oing instru nt �a^ knowledg before me
� '�(r 20�
The f r oing instr ert as knowledge efore me
this day 20� by
this day of l by
of
Jem- L -I I�� n s
Jam;, L
(Name of person acknowledging)
(Name of person acknowledging)
Qau
t of Notary State of Florida)
(Sig re of Notary Public- State of Florida )
(Sign re -Public-
i
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
aMy_4 Jenni L. Adkins
Type of Identification SS°
pSARYq�
Type of Identification Jenni L. Adkins
0
Produced o� �,� NOTARY PUBLIC
Produced Q ° NOTARY PUBLIC
TATE OF FLORIDA
c STATE 11O__F FLORIDA
GG061910
Commission No. J�; ♦•�r s 1/11/2021
Commission No. '� ? C bG061910
• NCE19��
p
Expires 1/11/2021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW "
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014