HomeMy WebLinkAboutPermit fo 5107 Indian Bend LaneAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' I -
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 4621578
PERMIT APPLICATION FOR:
Permit Number:
Building Permit Application
Commercial Residential
Address: 1 irlt'N iCA ) &nd L �
Legal Description:
Property Tax ID #: 1 3 eco " Ma t - ow C Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back; Right Side: Left Side:
Block No.
9 I -fir It Y -c- 3. S -I"c r it s
)NSTRUCTION INFORIeATIO I:
ii�ona�k to i perform" unser th s peri-nit - cfheck althat appiy:
Mechanical
Gas Tank
_ Gas Piping
— Shutters
_ Windows/ Doors
Electric
Plumbing
_ Sprinklers
— Generator—. -
_Raaf Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ :S '�Kcx:) . M
Name -t- es er iok �Ac',\_)-
Address: S10-1
Sq. Ft. of First Floor:
utilities
City: ay -i ple(ce State: -E—L
Zip Code: 3L -19S) Fax:
Phone No. Lr1 S 3 k _ LA L -I
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Sewer — Septic Building Height:
Name:ll�L-
Company: LO44Ay' 10 -1U'-1 lQf 1)� Q
Ad d ress:'l0CiQ 3 C CJX.(-)Q, J -00C
City: C D i eCCrC,- State:
Zip Code: 3iJ9 S
Fax: -1 �3`J8
Phone No -11;.- U3L4- Lici --
E-Mail L6C}� aI C �1 V cj,
State or County License CAS
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
�ITR�TCTION LIEN LAW INFORMATION
--
M13 i. M+ Ytz:Yl� F+� 1___
v
PLANS
E
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
REVIEW
Name:
REVIEW
Address:
REVIEW
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.
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 recvrdin_gyouur Notice of Commencement.
L c, C 4L
Signature -df Owner/ Less dWtohl ractor as Agent for Owner Signature d Contra ctor/Lic se e
STATE OF FLORIDA,,]/}} ' STATE OF FLORIDA r�
COUNTYOF Jlnh;Aty! I )VVK ;' COUNTYOF 1yr�/,yrl d�ly�>
The far oing instrument was acknowledged before me
this day of —! AnVi4 ::i 20_L9 by
(4ai6e of person ackAt3wledding )
=ate Y"p ar CATHIE LEE STULL
NotaryPabrc- StateofF!onda
(Signature of
Personally Known _
Type of Identification
Produced
Commission No.
2022
OR Produced Identification
(Seal)
The for oing instru ent was acknowledged before me
this day of api t_ r _/ / , 20 1 by
(Names of person ackn
(Signature of Notary
CATHIE LEE STULL
Notary Pdbk . - Stake of F'.orda
Cornmiss.on = GG 15633 1
Pff-R&OS Jan 27. 2x22
Personally Known _..__11X__ OR Produced Identification
Type of Identification
Produced
Commission No.
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014