HomeMy WebLinkAboutcaputo 1All APPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax (772)452-3578
PERMIT APPLICATION FOR:
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Legal Description:
Permit Number:
Building Permit Application
Commercial
Residential X_
Property TaullD#-?'AZLA— Lot MO- C�'7 -
Site Plan Name: C1 u%A-o Block No. 6Z
Project Name:
Setbacks Fn
Back: Right Side: Left Side:
I CONSTRUCTION INFORMATION:
_Mechanical _Gas Tank _Gas Piping _Shutters _/ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator V Roof trl,�zPitch
Total Sq. Ft of Construction: 7-700 Sq- Ft of First Floor 3 itA
Cost of Construction: $ 7040, zw Utilities: _Sewer _Septic Building Height:
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If value of construction is 2500 or more, a RECORDED Notice of Commencement is r*uired.
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2011
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: of 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: Gt1r
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. truce C— uritty m_ ekes no represer�pon that is gra�ng a penTA will authoree the hoibe r to build Che subien snr ucaw re
which is f1 mfnK[ with any app"bte tlonle Owners ASSocianon byiM
ni6, or an MYenant5 dut may re5[nCt 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 Budding Codes and SL Lurie County Aniiendmarts
The following building permit applications are eaempt from undergoing a full concurrency review.. room additions,
accessory structires, swerrin r6 pools, fences„ walls, sips, screen rooms and a coins ry uses to anotfnor naFnsdiential 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 r Notice of Com tt►encemenJIM.
Si of Owner/ Lessee/Contractor as Agent for Owner SignatYre of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORI II ''
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COUNTY OF �L (Vo _ COUNTY OF i`LV G.2�
The f'o-�rgoing instrument
nstr ent was cknowledg before me The(�(��W��� n ment w edg fore me
this ay of _��� 20� W this of 20 by
� c -l.IUO - Lo.('S e� LEa.0 oc- Lacs e�
(Name of pehtn acknowledging) (NjaTe of pers4A acknowledging)
`(Signal of oto ub i - State of Florida) (Signature of Nota blit- ate of Florida
Personally Known OR Produced Identification � Personally Known OR Produced Idetion
Type of - of Identification
ASHLEY FRECHETIE�
PROdnuDYd ., ..... aced
C-5tateol Florllfa
Notaryft ;in ,,, ASHLEY FRECH,
CommissioN000712fi /� n/ _
Commission No. i -'s: I My Cpmm.Expres Feb8,2 1C0 mission No.` 10.�� Notaryommissio
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``'�'cs c-.` 6ondeauwQ'�adp1alxatan sr. c,"�. My Comm. Eapresk 8,
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REVIEWS FRONT ZONING SUPERVISOR PLAINS
VEGETATION
, SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW
REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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2011
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