HomeMy WebLinkAboutpermit application ALL APPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 63 U04A
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01441119M R
Building Permit Application
Planning and Development Servlces
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-7553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To $elect from dropbox, click.arro"at the end of.�line
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Address: •34.1 9 _ k l.t�.r z tC l Coo
Legal Description: -TftfslE=
Property Tax ID#: "��'Zs Zo -b 3 3 9- o o- `r Lot No. oLt•L
Site Plan Naine: Block NO.'3 O
Project Name:
Setbacks Front Back: Right Side:. Left Side:
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ACICI it 1010 a worko e e orme un ert r5 permit-c ec all-fn appy:
HVA Gas Tank Gas Piping _Shutters
.� ❑ p g Windows/Doors
❑Electric Plumbing " ' ❑Sprink[ers ❑Generator ❑.Roof Roof pitch
Total Sq. Ft of Construction: S . Ft t of First Floor:
00 .
Cost of Construction:S C�Z So. Utiliti,es: _Sewer❑Septic.: Building Height:
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Name > A a~ "Y&11e N Name:_ e�E'6_ . _- /JGrneIora -
Address: '341cl r-ep-lw •Company: Gf_eA-J'• Aj:r• �t eE UetoljtFZ
City:t?0 r St L%>C-Itr Stater Address: /77P A•Zrn1=Y�i-JFL CtR4�L,,,_
Zip Code: 3446 a Fax: City:l7DcX 5-4� Loct'r< State: PV_
Phone No. 7 - '343- -IS-)9 Zip Code: X19 6�4Fax: 335. 190 Z
E-Mail: Phane Nd. 2.0-41
Fill in fee simple Title Holder on next page(if different E-Mail: •CLraAI f S'7*.
from the Owner listed above) State or County License: C/>rcv S b 66
If value of construction is$2500 or more,a RECORDED Notice of.Commencement is required.
OLG-J SOOO/WOOd OOL-1 -WOdA tiZ: U LL,-L8-20
DESIGNS .ENGINEER: _NotAp'plicable 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 cdrtifyrtt a't no work orinstallation has commenced prior-to.the•issi ance of a.permit.
St.Lucie Coun,. makes no representation that Is granting•a h�ermit will authorize the permit holder to build the subject structure
which is•ih cbn�ict with any applicable Home`Owners Association rules,'bylaws'or and covenants that rrfayYestrict or p'rohibit such
.ap
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may. ply-
In consideration of the granting of this requested permit,I do hereby agree that I will,in ail respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments..
Thefollot%dhg building permit.appllcations are.exempt from undergoing.q full copcprrency review;room additions,
accessory structures,swimming pools,fences,wails,signs,screen rooms and accessory uses to another.non-residential use
WARNING TO OWNER:Your fe'ilure to Reca'rd 4'N6ti6e•6f Commek6rtlerit 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 orrecordin our Not ide`of-Com-mervedment.
A1111 U s
Sig f Owner Lessee ontractor as Agent for Owner Sign ontractor/Ucense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5-t' L.r c € COUNTY OF -54 Lv ca 6
:Th'e forgoing instrument was acknowledged:befare nie• The'forgoinohn trument was acknowlEdged hefore'me'
this day.of (Tl R RC 20•L by this 3 i' day of JWA .Zp '17 by'.
(Name of person acknowledging) (Name.of person acknowledging)
(Signature of Notiij Public-State of Florida')' (Signature of Notary Public-State of Florida)
RersonallyKnown• -OR Produced)'deniification%• - . Persorially•Khdvn :/OR'ProducedIderitificatiop•: ' .
Type of ldentificdtion'Produced Type of Identification Produced
Commission No. (Seal) Commission No.
YP^W, 3�r SANDRA WALSH
,•trg
*t '{ MY COMMISSION•#FF091118 - ' ,�� EXPIRES April 11,20+8
Revised 07A5 cep I `� �" °'"`a p
.ci• ,,•• Ii-EXPIRES 80118. (407)398.0153 F1or1tldNotary/SBrvi_e.com
REVIEWS FRONT ZONING SUPERVISOR PLANS ''VEGETATION ' SEA TURTLE MANGROVE
COUNTER REVIEW. REVIEW ' ' REVIEW '`` ' 'REVIEFW ' RLVILW`.: REVfEW
DATE • •
COMPLETE
INITIALS
OL6-A £000/£000d OOL-1 -WOU 9Z: L[ L� �£-£0