HomeMy WebLinkAboutUntitled All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ( � ! �� t a
J Permit Number:
40(4 i
I
ris .
CO Li FJ TY kten,
F L O R 1 L? .R ----
Building Permit Application APR to 2r..
Planning and Development Services pe�lj
Building and Code Regulation Division §�rnder';.~ '
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 • Commercial • Residential X '
PERMIT APPLICATION FOR: cv , vvto•s3tt� Esv e"
PROPOSED IN!PR®VEMENT L®CATI®Nn. :m - .
Address: (et Z L t6 E2Ty Lt.)A�( 'F Pl.e e-c --L 3q.'I SI
Legal Description: Fj-L- ,4t(Z 5 i res 'Lk.. l LOT- Z (nvt_ 3Z^t S.-15766;D
Property Tax ID#: 13(2 -20( 0h03 'OL1.L Lot No.
Site Plan Name: P- -5 l.oEe.)GE l Kowt.C."-- Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
SAILED DESCRIPTION .WORK `
.� . Y.a....o�d.... '',. . .A..:... n., e«.,... � ,_ '..e- . . m .... te. '. ..
-tb 26w/.b ut= ,a,.JI' P&c sct-w6(.tc-`5 2/ (?_ 1'trct-t-
CONSTRUCTION:INP®RMATIONn ::.J.
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors, •
Electric _Plumbing _Sprinklers _Generator X Roof Z`l� Pitch
Total Sq. Ft of Construction: 1.L(DO Sq. Ft. of First Floor: . . - _
. Cost of Construction: $ S---,(Z Utilities: _Sewer Septic Building Height: % s roiz_y
OWNER/LES�SEEoT4 ` . % CONTRACTOR° `.
Name WLU-1.l4w-is 11-.6"k NA 14,rE51-t;l2 Name: Sc—(.,-;-vc`ts C"S'r"asaEsw4-y. ,
Address: lT-z.- 1,11150int9 V-—fCompany: eAs.rbNetiva.y 'Pco W6- U..4_
City: 'Fr Plc.-17.1.6 State:rL Address:32`z( nt rp.se_ A-'-'
Zip Code: 3'tit'/ Fax: ' City: cc pcei266 State: Ee_
Phone No. 17-2.- 3 Z?, --5-1 q g Zip Code: 3 ii KZ Fax: 772 444(-4 44 re
E-Mail: Phone No -v-Z Z lb—k64"/
Fill in fee simple Title Holder on next page(if different E-Mail [SLS 0.061AEcy C2GGRAfke X 6614.414.e603.4,v
from the Owner listed above) State or County License CCGDS'S4'Z '/ 16'2-01
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
•
g .. ..: �;�a• a ��
SUPPLBMENTAL C®NSTRUCTI®N LIEN LAW I'NIFORMATIONb
DESIGNER/ENGINEER: Not Applicable 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:
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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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 fa' . = to Record a Notice of Commencement may result in your paying twice for
improvements to yo "pro -rty. Notice of Commencement must be recorded and •s -ted on the jobsite
before the fir t ins : 'dn. If y• intend to obtain financing, consult with le• e • - .ttorney before
commenci ,:.1wo • recor.• : our Notice of Commencement.
Signature of r/Lessee/Contractor as Agent for Owner Signature. Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF - LLA_
C 2
The forgoing instrument was acknowledged before me The forgoing instrument jas acknowledged before me
this 10 day of �� �
, 20 (K by this I 0 day of r' 1 , 20 1 K by
yen ;P Cas n 9 LA-01 v-e=n ag+0 9' .
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Nota Public-State of Florida ) (Signature of Notary ublic-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced 'OL
ivEN e m
Na'F S
Commission No. GES'eal,S �: DEANNAPa9f('�pIENS
f.�,' PdyC ; ,�,ION#�G022023 Commission NO. Z a �„
2°``'; Y'..'= Nay 0.ommASSI N#G 0220,23
'= EXPIRES:December 16,2020 _ X020
0 = ' ,,� r^1blicUnden �' _;� _ FXPIRES:December16,
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":)4 :ss , •r''ep:;�' P.om e.
REVIEWS FROOa: "° N1 G SUPERVISOR PLANS VEGE Wrf -I' LE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
'ley. 7/2014