HomeMy WebLinkAboutPermit for 4180 N A1A LobbyAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
-Date. Permit Number:
a
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:
PROPOSED IIVPROVEMENT LOCATION
£� „
a 'te�''a�,
Address: LA l
Legal Description:
Property Tax ID tt: I 5Qu - m _ QCT 0 Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Brick: - Right Side: Left Side:
DETAI EO DESCRIPTION OF INS
C
t ccc- J
Sr -
�itiona
CTION INFORMATION.
rk to b- pe- r�mecl-underTis permit — check all fat apply:
'- l e c h a n i c a I
Electric
Total Sq. Ft of Construction:
Gas Tank
Plumbing
Gas Piping
— Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Cost of Construction: $ c4ci too. oc) utilities
l ame ICEIGr x I LC
A' dresc - C�.. fox 3,;)Oto3 1
Ci = ;. aCM State: PL
Zi Fax:
Phone No. a-1- LIS -3- 53UQ
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Nan
Con
Add
Windows/Doors
Roof Pitch
Sewer _ Septic Building Height:
7==]**
any:
City: -A- ►SCI? state: -6 -
Zip Code: 3L40L I Fax: MQ_90I--53cff
Phone Nom -12 -- (t, 39 - QLAS 1
E -Mail GL �J- So E 0_ q fr CZi CoC'"1
State or County License L6��
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Not Applicable
MORTGAGE COMPANY:
� pp
DESIGNER/ENGINEER: ,�
Name:
Name:
Address:
Address;
State:
Cit
State:
City:
Zip Phone:
Zip: Phone
Not Applicable
BONDING COMPANY;
Not Applicable
FEE SIMPLE TITLE HOLDER:
Name:
Name:
Address:
Address:
City:
City:Phone:
Phone:
Zip: —�-�
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 ahoy} ws ar andpcouenaonds that rnaydrestrietbor proh bit such
which is in conflict with any applicable Horne Qwners Association rules,
structure. Please consult with your Home Owners Ass ociat4on and review your deed far 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.
�Sigin;a':�,ture
�L
Owner/ Les eUntra�cto�tfor Owner Signature of antractor/Licen o er
STATE OF FLOR A STATE OF FLORSf- `
COUNTY OF Luc (� _ COUNTY OF
The oing instr ent was a knowledge�d�']before me
this day of I xo-�--+ by
(Name of person aeknowle ng )
(Signature of Notary Public
Personally Know
Type of Identific,
Produced
Commission No.
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ev.
of Florida )
Frociuceu iuei
KRISTINE HOPKINS
Notary PuGlic - State of Florida
isslon * GG 066127
MY Comm. Ewge an 25, 2021
Thoing instr t was acknowledg efore me
thisZ 4 day of t� 2d by
n ["� t�11 2rctom
(Name olf person acknow
(Signature of Notary Public -
Personally Known"
Type of Identification
Produced
Commission No,
to of Florida)
Identification
�ublrcState o� orida
�Erf
Commilfi;w� at
4,1111-4111p,Y COrrim, E GG 066
Aires Jan 25,x27 20.,,
ZONING SUPERVISOR EVIEW RPLA EVI W V�ETAT
ION �SE �RT
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REVIEW