HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: V)
RHEI'.'
`1 JAN 0 0 ?0,17
..
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
PERMIT APPLICATION FOR:
PROPOSE 1 INP �®VE ENT LO ATION:
Address: LANLL GcrZ i` 5L eL 3 r- 5 L
Legal Description: �� 5 VLEwZJ S1,j4jJ,4_� LL. _e3oZ-
Property Tax ID#: X312_ {L _70 L DI H OC22 2 Lot No. �}
Site Plan Name: l(, 6>�G� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
=11!!1111! 1
OR .
CQ S R 10 INFORMATION:
Additional work to be pertormeci 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: C 0 Sq. Ft. of First Floor:
Cost of Construction:$ S&CXR```' Utilities: _Sewer _Septic Building Height: 10 C--T-
OR
CO R OR
Name [(l%CA2 !Name: SSI-UtN� dao CLC.
Addr,.ess: 29, 3. (f�2i iEc� Ue iC Uct- Company: ..S ci
City: FSS L_ State:rL Address: 32_ [' (�Lj� AUEF
Zip Code:34-`t 5-Z Fax: City: "F-� ��,�=� State: i--(
Phone No. -?7-?- -J 4f S� (�j l,`7 Zip Code: Fax:--Y22_ 4(,o[`uL�-5-
E-Mail: l Phone No 7-4o 904-7
Fill in fee simple Title Holder on next page (if different E-Mail - (� l� � • 6-,,
from the Owner listed above) State or County License 666Z)S_sn3 t 0-?-?aI
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
IF
MMMUMMOM IUM UM BUMMMOMC01
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 y9ur property. A Notice of Commencement must be recorded and posted on the jobsite
before the firVorkc�wc�rflcording
' n. If you intend to obtain financing, consult with lend e n attorney before
commencin our Noticeof Commencement.
Signature of Owner Lessee/Contractor as Agent for Owner Signature of Con ractor/LI er
STATE OF
COUNTY OFOS�. t- VC'\K COUNTY O, STATE OF F
The forgoing instrur fent was acknowledged before me The forgoing instrument was acknowledged before me
this <�, day of J 4"1\ ,20Aa by this CP day ofSa► ,201 by
Q, 'J'4- gSov. <v� CcxS-�oV'% k)
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publ -State of Florida) 11 (Signature of Notary P lic-State of Florida)
Personally Known OR Produced Identification :V Personally Known OR Produced Identification
Type of Identification Type of Identificati
Produced L Produced L' •�•r'��N DEANNA MARIE GIVENS
DEANNA MARIE ENS :+.� '= MY COMMISSION#GG 022023
#GG 022023
Commission No. S �1 M 18,2020 Commission NO. i EXPIRES:D16,2020
'w �d; P TW Nary PublicUnderv+dters '0 ,,.• ondedT1vuNo underwriters
Ban.oic Bonded
F F FL,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.