HomeMy WebLinkAboutappAll APPLICABLE
INFO
+MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / 'o ` Permit Number: \d�o-k-d3LJq
RECEI\/t-
__ Building Permit Applicati , n
Planning and Development Services J U L I . 19
Building and Code Regulation Division ST, 1_.i.iei4 i:ounty, Per
2300 Virginia Avenue, Fort Pierce FL 34982 -- --
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address:
ng
Property Tax ID #: 1 fbb1 lo(�LI - CMG ,nD 2)- 000 - ' Lot No.�J
Site Plan Name: Block No. c--')Ll n
Project Name: ` e � 1
z A V41
CQNST ION,,( RMATION:' �
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: -55)\\b
Cost of Construction: $ --)
Generator
Sq. Ft. of First Floor:
_ Windows/Doors
oaf %tch
Utilities: —Sewer _Septic Building Height:
Name I (X- i , U
Address: F50 t P, lie 1CCr"-e
City: - {'A statea
Zip Code: 51 Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
)) ) Kko CY
Company:
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Address: G
S�
13 1
City:
Zip Code:
Phone No--iJ
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i
O , Stater
Fax:
-13-&t0(-/
E-Mail
State or County License O('
It value of construction is !�Z50O or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
5UPPl E ENTaL Ct�NS RUCTIa(U�LI N LAW I�F
DESIGNER/ENGINEER: _ Not Applicable
RIVI '(C _ � � 'RK
�.
MORTGAGE COMPANY: ` Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: 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 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 TOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Si nature of Owne ontrac as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLO�STATE
COUNTY O —Ii<3 lo)A
��
OF FLORIP4
COUNTY OF
The forgop ing ins was acknowledg efore me
this �' day off k x 20 by
The forgoing in um nt w s acknowledg efore me
t day o 20 y
s)
Name of person making yat ent.
-.
WSAL)Gl.lL
Name of person making statement.
Personally Known OR Produced Identification
Personally Known •G/ OR Produced Identification
Type of Identification
Type of Identification
Produced th
Prod _
.01110 �. ,tary ES�bIiC Stet@ Of Florida
4P �, ^,.rna.:a P anderson
• r: y C.. nss %n GG 214256
nllL•'^�22
go P Notary PublIC State. of Pon
4? 1K Amanda P Oanderstir.
My Commission GG 21'�25•
Ex Tres 04/25/2022
(Signature o -
(Sign Ica -Ida )
//
Commission N aW (Seal)
Commission No (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
iev.2/7/19
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