HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \ {J 1 Permit Number:Mm
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Building Permit Application
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 —L�
PERMIT APPLICATION FOR:
I&WIM Pula
PR"M(O SED M'ENMORMONS N:
Address: �(�o� �a���n.✓d 8 Qct
Legal Description:
PropertyTaxlD#: � d�'�O \1" d3 "400� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CON�TUC ION INFORiA.TIOISS
:
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ J. ado_ Utilities: —Sewer _Septic Building Height:
O : N E CDNTR CTO
Name ,,. ,1,J17i � r Name:
Address: ..G g°. -La.xr"7�.�d n.[ r/jam_ Company:. G 5 �o%eGe�t�ic, LC
City: or� Ae,rG,° State:_ Address:
Zip Code: Fax: City: Ile," �e,&qa4 State:��'
Phone No. 3)H - Zip Code: 3 Z OM Fax: 77VAY-09Yf
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail �Ig 144
from the Owner listed above) State County License e�G f3 00 Z fZ-L-
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
=.UIPPLEMENTAL CONSTR!tJCTI:ON LIEN LAW INFORMATION:
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 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
commencing work or recording our Notice of Commencement.
Signato of Owner/Lessee/Contractor as Agent for Owner Signature Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF Sk COUNTY OF __-sk Luce
The forgoing instrument was acknowledged before me The forgoing instruTg nt was acknowledged before me
this 5 day of Io;4-1 20\1 by this S day of J0/4 - 20a by
G \) 4 Vh0G G e y w.�a ',f-el- .
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu -State of Florida) (Signature of Notary PuAl State of Florida)
Personally Known OR Produced Identificat' �— Personally Known OR Produced Identification
Type of Identification Type of Identific
Produced D€ANNp`�IEGIVENS 23 Produced ,_' " -! DEANNAMARIEGIVENS
SION#GG 0220 #GG 022023
;;s:• MY GOM S.��Ba,,,m�bye,r 16.2020 i '•.' EXPIRES:Dece�l6er 16,2020
Commission No. eIdTWNbtts�`7 HaunaervrtRere Commission NO � TfuuNotaryP{ rrwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014