HomeMy WebLinkAboutPermit for 7003 Fort Walton AveAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C - N % Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1.553 Fax: (772) 452-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATION: _ �Nrz
Address: xA LQc- Vt(�_ �e
Legal Description:
Property Tax ID #: ( l (P I D d 19 C-1 - 000 _ A Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
AlLFD DESCRIPTION OF
Block No.
_ti i 1� C {i-�( 1► Ir)',u�I (u 1 l CSU
_�-
:CONSTRUCTION INFORMATION. - x ;
Ad �tiona wor to be�rmec�under��is permit - c�ieck ai�tFiat app
Mechanical Gas Tank _ Gas Piping — Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers — Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 331SO,
Sq. Ft. of First Floor: _
Utilities: Sewer _ Septic
Name ttJ:T P F -t-Flat
Address:_1003 L-A Av
City: 0 % ecce State: EL
Zip Code: 399S I Fax:
Phone No. )O i-1 1
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height:
Name: (_T4 l L -(_u- F-- --
Company. -A I f 1 )-t-1of ct�
Address: C CC 03 CC*_)a—'1QL LQ+X
City: State:—f--(—
Zip Code:Fax:
Phone No �l`I'�� U y 91
E -Mail C:ODl �l"�U� 1'`t-"�CA I ,Cts
State or County License C A 19 I C 'Q C1
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER
Name:_
Address:
City: _
Zip:
Phone
LAVA IINFORMATI
Not Applicable I MORTGAGE COMPANY: Not Applicable
State
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:_
Address:
City:
Zip:
Phone:
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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. 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
rrnmmanrina Wnrle nr rarnrriina vniir Nntira of Cnmmenceme_nt.
Rev. 7/2014
Signature f Owner/ Lessoohlractor as Agent for Owner
Signature of Contra ctor/Lic e er
STATE OF FLORIDA
STATE OF FLORIDA /}
COUNTY OF ysl,l,n7 V�Yy
COUNTY OF yi %i1 ---
The forgoing instrurVent was acknowledged before me
The fing instrument was acknowledged before me
thisday of 2Q %c5by
this day of A n s�r9 20J'by
(k.Ae of person ack wled ing)
(Nami of person ackn
2Qi'nY aU8<,^ . CATHfE LEE STIJLL
CATHIE LEE STULI
Notary P 14iiC - Stale of r''o da
i'olaryP�ilc-Slatea'Florida
. +
_,T, r= Comrls�a GG °5a 3?
of No#
(Signature y. ,,.;., -Sta af.ws �27 2622
(Signature of Notary btic°`Siafe of*f T'fd�otJe5Jai27,2022
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No. (Seal)
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