HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: vo Permit Number: VI (o
RECEI -0 JAN 10 21
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: To Select from dropbox, click arrow at the end of line C\C—
PROPOSED IMPROVEMENT LOCATION:
Address: A2J=2�1 j�jj?sR(_l PLAC4
Legal Description: 2c',,�ap_uY_ 94-sr- 0 k M-55 P z-
Property Tax ID#: 3322<1 96 9 6US 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
(�GPt�tL£. _..J19M�, ri7J�-.��'1� � �c9n> �G $�S5'e�►j
Lan�lfiin�S���i��+ 4 T�� 1[•v r,,/j�-o s-�-g-r.
CONSTRUCTION INFORMATION:
iti a workto e performed under this permit—check a appy:
HVAC Gas Tank 0Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities:0Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name V,_c, Name:
Address: f 0 1 o q 01Rv56. 21 Company: d9(„9 `�=r��=l1�1 A,E PNC
City: Q S• l- State:SL Address: yz f-4vP.t2o1j La
Zip Code: °Ie,G Fax: City: ? State:
Phone No. 129 3229 Zip Code: �3�4 G 3 Fax:
E-Mail: Phone No. Q,T)b a15,1_f
Fill in fee simple Title Holder on next page(if different E-Mail: lla414t9,f 0_ 0,>me4S"7�
from the Owner listed above) State or County License: e 14 co �±P, l
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION 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:
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 recoVding your Notice of Commencement.
R
S
Signa 0 ner ssee/Contractor as Agent for Owner Signatur Contractor/License Holder
STATE OF FLORIDA STATE OF FLORjDA vc`�
COUNTY OF S�. Lo c \'Q, COUNTY OF S
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this \0 day of 7S%*n 20 0-by this 6 day of 7Sg-f\ ,20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publ State of Florida) (Signature of Nota ublic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Pro uced Identification
Type of Identification Produced t- L Type of Identifica '
DEAN MARIE GN%5 ftlln73 •,.••tip....
l _ DEANNA MARIE GIVENS
Commission No. OOMWSSQN#GG Commission No. = COMMISSI4SWO022023
Notary I PFF� • I � bk 16,2020
EXPIRESBonded Tfw Notary undemriters
Revised 07/15/20
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS