HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,A1 -
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED h
Date: Permit Number: O 1 -oo L�l?
6GANNE®
=RECEIVF-D? �11CB �OUI11i / BUI
Ing er It Applica
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential J�
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 20.4J
Property Tax ID N: - ?7 - 000 -..I Lot No.
Site Plan Name: AIn fi [ .0. Ci e Block No.
Project Name:
DETAILED DES •RIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
✓Mechanical _Gas Tank` _Gas Piping _ShuttersWindows/Doors
Electric AcIflumbing _Sprinklers _Generator _,[Roof /a.. Pitch
Total S Ft of Construction: / q. f�QS Sq. Ft. of First Floor:
Cost of Construction: $ Jb52nl@q G 7 7L Utilities: —sewer Septic Building Height: /.3!
OWNER/LESSEE:
CONTRACTOR: y4
c:
;Name'
'Addres' G
,Company:' 1 y\1 C 611
Cityi i ,_ ..State:.
Address: Q i We qc 97-5
-Cityi" r1160.,YT,,l -State:.
,Zip Code_- _, Fax: -
Phone No. ' 77i $- S37 �- O t
Zip Code: -_ 17 !� Fax:
E-Mail: w to�L�Q 6Sc /•g�/�?Tv jai . ���
Phone No % c q
Fill in fee simple Title Holder on next page (if different
E-Mail1
State or County License C
from the Owner listed above)
State of
If value of construction is $2500 or more, a RECORDED Notice of Commencement nt t'�• day of
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is regUr&e me pergorwl ap ared
' "• CHRISTINA PEREZ
?:_
• to me known to be the person who executed the
.r MY COMMISSION d GG077417 foregoing Instrument, and acknowledged that he
SUPPLEMENTAL CONSTRUCT ON L E LAW INFORM
TION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip:. Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 concurreniy 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH Yn11R 1 FNOFR nR AN ATTORNFY RFFnRF RFCORnINr. YnnR NOTICE OF COMMENCEMENT."
SignaturAf of Owner/ Lessee7Contractor as Agent for Owner
Signatu a of Contractor/License Holder
STATE OF FLORWA
STATE OF FLO IDA
COUNTY OF b90 �jR� l t�t2.
t
COUNTY OF 021 SaZ�k
The forggoing instrume2n was acknowledged before me
mday "JQT�_
The forgoing instrument was acknowledged before me
__3ix-.P {�
this of , 20 1a by
this 2`aday of _ , 20 by
Name of person making statement.
Name of person making statement.
i.
Personally Known OR Produced Identification
Personally Known _ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
;' • ;
i CHRISTINA
(Signature of Notary Public- State of Florida) ""
tf 1h'f o ub ic-State' 1 .1 MY COMI
f �,,
Commission No. t7 �"�' \� (Seal)
GGa 7417 EXPIRES February
PIRES Feb a
ft
CommisiWa?7 2021 Seal
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
nev. Z/ // 17 _ )`L^iiac. ylle: a•9Lk.+' g
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2021