HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLEYNFO MUST 13E Cot
Date:
1;°TED FOR APPLICATION TO BE ACCEPTI
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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
Address:
Legal De!
Permit Number:
RECEIVEL)
Q13L 15 ?Q19
ST. Lucie County, Permitting
Residential
3S5 l2aF r 39
Property Tax ID #: Z3 Zd -Sd (- 6C3rnZ-ocxj - 9 Lot No. IG
Site Plan Name: Block No.
Back: IC/o Right Side: 56 Left Side: 19V _
C- KA=)VV\, — L— 0ry"44/ k%IZ77 -
C-J — k--5 —10jzZ �
n//Mechanical _Gas Tank _Gas Piping _Shutters `Windows/Doors
,,,,Electric V Iumbing/ \ _Sprinklers _Generator /Roof
Total Sq. Ft of Construction: b � Sq. Ft. of First Floor: R60
Cost of Construction: $ 1 Utilities: —Sewer Septic Building Height: /8
2 . 77 ,Ga
i F {{y, t - pfiT
'rxn"'�,a# y `$ fN`-fin-'.
3
2�9 i t-+'-0
Name 4?0 1_ ai
City:•Address:
Zip ••-
•
HolderFill in fee simple Title nextdifferentpageA
from the Owner listed above)
State or County License: I
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
GINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
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F
U�e.(C�( Name:
ot YS`I W "8-, t ov ce d ST Address:
�S t_ Stater City: / State:
f Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City: /
ZIP: Phone:
Zip: done:
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 holder to build the subject structure
structure. Please Home lour
consult with your OwOwnersUp4ermit
ers Psso iciCation°and review
deed for any restrictions which a or prohibit such V Y Y Y PPY
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, sighs, 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 jobsite
before the first inspection. If you intend to obtain financing, co i der or an attorney before
com nc' or r ordin our Notice of Commencem t.
nature of Owne / Lessee
Signat re of Contr or/License Holder
STATE OF FLORJpq -
STATE OF FLORIDAzX
COUNTY OF 0 �r `� jC\2
COUNTY OF \31
The fgrgoing instr4ment was acknowledged before me
this�dayof JtN
The for ing instrument:was acknowledged before me
SV
�20Aby
this3dayof 20I�by
V
A�Person
(Name of person acknowledging)
(Name of knowledging )
(Signature of Notary Public- StEhe of Florda)
(Signature of Notary Public- Stile of Florida )
Personally Known OR Produced Identification
Type tBARBRJt A LAN
Personally Known OR Produced Identification
of Identificatio Produced_ �rP°4,�
Type of Identificati n roduced s»�yb BARW AGOODMAN
� , '� 1��'i�sy�(
Commission N6p% 9 al
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Commission No m P.
(s'�'�+ S March20,2022
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