HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /b��/ I b Permit Number:
- RECEI�'�D Ci,i 0 ? ?.016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Aven ue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential l/
PERMIT APPLICATION FOR: GAS � w4
Address
Legal Description:
Property Tax ID#: /q-K2 - g
0 4� - olo Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ERWIN
1��0.��,1 ca °.S r.✓w��r' LiP�' f� C�.w�C�G+..
Additional work to be pertormed under this permit-check a H that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ :zoo 00 Utilities: _Sewer _Septic Building Height:
-----
l?1l1�1�
Name `l.Jc%�% e;'l/ rJb�r.�So✓�" Name: ti :,Sam
Address: ' �06! /�, ,,eS r'��J ', j Company
City: ��• P,'���.... :-. State: 1 Address:II 170'1 -
Zip Code: 3`'��l Fax: City: �T, �,�-t.Q_ State:
Phone NoL77L) �t(l - �3/ y Zip Code: Ll - Fax:
E-Mail: Phone No(_7 :� �0 L - 3573
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner'listed above) State or County License 2,2(910
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable 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 Raying 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 wit lender or an attorney before
commencing w rk or recording our Noti o Commencement.
Signature of Owner/Agent/Lessee/Co rr&actor ignature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA ,
COUNTY OF I-t3co, COUNTY OF mak.
The forgoing instrumentwas acknowledged before me The forgoing instrument was acknowledged before me
thisA_ day of CNC;T 20% by this '�_day of 20_�G by
(Name of person acknowledging) (Name of person acknowledging) �
(Signature of Notary' Pu c-State of Florida ) (Signature of Notary Pubk--State of Florida )
Personally Known OR Produced Identification Personally Known . OR Produced Identification
Type of Identification Type of Identification j
Produced L NS Produced — . �, DEANNAMARIE GIVENS
DEANru"MARIE On023 _ _ ISSION#GG 022023
COMMISSION# r 16. p(pmber 16,2020
Commission No. ' '(pIRES��@ ,be 2020Se� Commission No. °- BMW=�ublicUnderwrlW
.'c NotariP.04Underxrl .».,.
8ondedllw
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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