HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c-t , L Permit Number: —
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Planning and Development Services '°e/b7/4,., 06'
Building and Code Regulation Division )9 p Off®
2300 Virginia Avenue,Fort Pierce FL 34982 �c� c'0 arb*
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential tot),oh,
PERMIT APPLICATION FOR:.
PROPOSED.INPROVEMENT LOCATION
Address: 3 o r) 0 /Z aJ e ;,5 Cce, 11, f g'-'e r c 2. /r7
Legal Description:
Property Tax ID#: Z Li3ol' 1 ( t ' 000 4 c7c7a — (-P Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank Gas Piping _Shutters _Windows/Doors,
Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
00
Cost of Construction:$ ,2 3 C'C) Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE „ CONTRACTOR:
Name rrti 3 S*a\dt%-rVe An:cid Name:^A,S it L . S7--c.„‘_ ,,o i.7c
e
Address. '"?.010 2.5-ei'3 12_0( Company:•,:,:
City`. #f-- ftt'r-t .:• . State: Ff Address:• „ l — L'
Zip Code: 3t-t ligi Fax: i City: /—F ,-c; JO, z,•L.-<_, Stater
Phone No. 11v1- '3 52 -173/ Zip Code: 3`itg(5- l Fax:
E-Mail: Phone No `7 7 2_ 3 2 S ('
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License ('
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
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 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 recording your Notice of Commencement.
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C ,^S;,SY KIMBERLEE ASHLEY C/ �J�IY
o ti KIMBERLEEASHLEY
" ' �^ MY COMMIS ION$FF 5AA38 b.`"--1-----
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` ' ' * ISSION#FF 958838
Signature of Owner/Lessee!Conti e kis Ag&fnitE 0Fe(i 5949 9 2 020 Signature of Contractor/License '. Sib
°np F�ngz' Bonded Thru Budget Notary Services �j , aP EXPIRES;February 9,2020
FOF F�O� Bonded Thru Budget Notary Services
STATE OF FLORI STATE OF FLORIDA_1 9
COUNTY OF "'• \ 0,\ P COUNTY OF C_- i • l,Q.�U I e.
The f r oing instru ent was acknowledged before me The f r oing instru ent was acknowledged before me
this ay of V\ , ,20`'by thiday of rl I , 20( by,
�Te- Ca{ re`U i Q }ci r6,,_) Co d i .e
(Name of person acknowledging) (Name of person acknowledging)
%. t t�1 r��,1�� ` ,.rani � 4
(Signatu e of Notary Public-------
ublic�-State of Florida ) (S':natu e of Notary Public----
ubl�ic-S ate of Florida )
Personally Known �� OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
of Y�"E, KIMBERLEEASHLEY YP
•• ••c ae (B '441W' LEEASHlE(
Commission No. * �� (, MY��'��I�SIONMFF958833 Commission No. 4' rrr�
G 1�{ !(��ON#FF 958838.
0.,44 5Al o EXPIRES:February 9,202E m t1t cv y;'EXPIRES:Feb'iva 9;2020
4 `' e. BodedThruBudgetNotaryServices ..•.e;',,... ..... 'y .> a. ry;
OF F4 ''"i`�;��OF.F,,q1' •"`.`Pi,dnd U 9� • fNo±;yFerhoas
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION .'.;:SEA'TURTLE MANGROVE
COUNTER REVIEW. REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED ,
DATE
COMPLETED
ley. 7/2014