HomeMy WebLinkAbout1805-0243 ALL APPLIC9BL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: , 1p i 3--
Permit Number: )612 5`COY.-71
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wain -imuisaimm Building Permit Application
Planning and Development Services 44241/0
Building and Code Regulation Division Ato 08
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resi ittleAstiy
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: '-'1417,e) /A)a.41-elgatiDTZ- PL—PL '- (-AQIi k.)
Legal Description: kil 4. r ...-,-,-,--.. A _ C___ \ — 1-q-411.
Property Tax ID#: .-- -_ ,F--1-S-CA.— CO2 it-)a --(Er) Lot No. -kC)
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK 1 - • . - ,,
14 \l' el 4 140'1/30 oa- (9 .--7-121/4-1L.). --LeS. UL)A sree-14 erlitiaS
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CONSTRUCTION INFORMATION: ' • -7. , - •- _ , - ., „ ,•-•„ ,
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Additional work to bigarormed under this permit-check all "hat apply:
r-HVAC Ga Tank Gas Piping Shutters 0 Windows/Doors
....=.-.-
Electric Plumbing [I:Sprinklers -Generator Roof Roof pitch
_
Total Sq. Ft of Construction: *—b ---- SVII of First Floor:
Cost of Construction:$ \CkCX:› Utilities: [ 'Sewer Septic Building Height:
OWNER/LESSEE: ' '- - '' ' ' • CONTRACTOR:
Name A.„,..5.)\-- g L,Apcittet-A.,6, Name: "let..)PA-W.----PiVit,M...& OkUvi4.\-310L1
Add ress:- 1 P1/41471A0rexiC::e......-bz...- Company:
City: I ,L._ State: FL.-- Address: n_30.(2,i .A.-a.q.c)k) LA-14je
Zip Code: I' cri.4e„ 1.c. Fax: City: 1()pi4-6-2 State: ,--
Phone No.' fl —€;12.--:?.'.-21 Zip Code: *S:: (-4-021 Fax:
E-Mail: TOL aiCiap•pc): -0L.- -...A. Phone No. 5 12313-1
Fill in fee simple Title Holder on next page(if different E-Mail: 1.-1 P 0 IL . LI NiCip.00--,--
from the Owner listed above) State or County License:
(1 Faak-11_1,-,611 Z.—
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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CONSTRUCTION' �`` ��n ' �
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DESIGNER/ENGINEER: 1/motAoo|icahke MORTGAGE CO&N9ANY: Aoc|�ab|e
Name: Name: --- ' '
Address: Address:
City: State: State:
Zip: Phone ZipPhone:
FEE SIMPLE TITLE HOLDER: 17.4., Not Applicable BONDING COMPANY: ~^<lotApplicable
Name: ntm\- Name:
Address: Sk. y) Address:
Zip:City: - Phone: ZipPhone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no woror installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is it h |d build th
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 reested 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.ANot|ceofCoA1rneDcemnentrnustberecordedandposted jobsiteonthe
before the�rstinspect' . |f dtnobtain finandng, con nderor re
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- � ' Notice .
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Signature of Owner!Lessee/Contractors AL-nt for
-�� owner Signature of Contractor/Licens
STATE OF FLORIDA ' ' STATE OF FW0RU /
COUNTY OF �� � �� � v_��� COUNTY ^ /
The �m acknowledgedbefore me The foinstrument was acknowledged before me
this_��/dayof by this �fwhayof 2O4, by
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��� � ,_/,/,,,-/e. �r,r,,,,,„ /..) „,,-,--,,,,
Name of person making statement Name of person making statement
Personally Known OR Produced Identification ^~~-. Personally Known- OR Produced Identification /~—
Typnof|dentificaUnn Type of Identification |
Produced /�/ /)g/k/4-- ,^///�1.-r7t71z~ Produced /�� /��^—»rm---- }
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i �' ^-'-'�� ^� ~'�� -~� � ~��. ____L__d, /~ ~�~� �,u
(5iXnotueofNut� Pub|cState ofF|nhda) (Signature of Notary P "Uc-��ateofFlorida)
Commission No.6-/ '/ 1.9 716 (Seal) Commission No. 97 ?6, ` .... ' , ' . /
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2021�
REVIE
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IV 10. NTERnissio 4TEVTEW REVIEW REVIEW REVIEW REVIEW IIMMIll
CDOATMEPLETED 11111111111111111111111111111111111111111111111111111111111
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