HomeMy WebLinkAboutUntitled All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
j o5 - 0 -7D3
COU IN
F L O R A 0 . -- MAY 2 6018
Building Permit ApplicationPQ,,,,,„,non® artent
Planning and Development Services St LUC1e county
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED ON PROVE RV LOCATIONo,. '”
Address: ,Z5-4?1,1,, £ri'/e /c--/. A'#- e /2 3 y9y7 I.
Legal Description: C ...:;pial Gopto 40c SeS, -i On '.E3ik '- Lc, O 4"J4/
//1/, of Vac. lite all; an 5 ( 13i / ')
Property Tax ID#: /V0ZS — 70/ - 00.2..1 - GOO'.9 Lot No. 8
Site Plan Name: /+,,a 47 E'si�PhCe Block No. ,..2.._Project Name: /' pkv 163- e V
Setbacks Front 3 V. 4" Back: /r,3' Right Side: /Y ) Left Side: .2- ,'2"
DRUM DESCRIPTION QV WORK $. -..
.. hs // G P. G..4,•>'<e "l/c._ sem/,' ,04"e I Aht es
CONSTRaUCTI® INFORMATION?
;
Additional work to be performed under this permit-check all that apply: 1L71/ t
_Mechanical _Gas Tank Gas Piping _Shutters —Windows/Doors
—Electric —Plumbing _Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ .2 000, Utilities: _Sewer _Septic Building Height:
OWNER/LES-SEEoCONTRACTOR° : ;L :.
Name ,VCvi h 7Y0 6 Py, Name: 6;-/as.7 /AA e Alt
Address: 6060 (/essice? ,2rike Company: . r)ah /9e Is e /h 6:74s A lex,
City: .q,,,,/,,E•a State: /r` Address:= 02 40" 4i„:�i. 10r,ke
Zip Code: 3,2 70 3 Fax: City: /7, ,/'rise. e State: /�L
Phone No. 702 - 7,79 - a2 c2 6 / Zip Code: 3 Y?91 Fax:
E-Mail: 1,,..snv,de yll.0q, gy,,1o/7 ,co Phone No 772 -42/6 -/3'$'
Fill in fee simple Title Holder on next✓ page(if different E-Mail 4/`iae, `Je/se/A a2 yci/o.r..2, eos,
from the Owner listed above) State or County License G&C-/5/8 7 02.a._
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
.4 CONSTRUCTION- i �i $
SU�PP' LEMENI'�L LIEsN LAW INFORIVIATIONa ��� � ' .�: _
". ., � -_ ,-0:1 a.a "^ t: � ' � t
DESIGNER/ENGINEER: _ _Not Applicable MORTGAGE COMP NY: Not Applicable
Name: ' Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE OLDER: Not Applicable BONDING COMP Y: Not Applicable
Name: - Name: �r
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
commencin: work or recordin• our otice of ommencement.
-- .'" /__,_____Ze
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA- STATE OF FLORIDA l
COUNTY OF f-- Lt.A-C �_, COUNTY OF �,T •C,A,t. c..-/::e.-
The
ie'LThe for g instrument was acknowledged before me The fowling instrument was acknowledged before me
this �/>day of 200 by this Z3day 9k,L&,v ,20 ('by
(Name of person acknowledging) (Name of person acknowledging)
S nature of NotaryPublic-Cate of Florida (Signature of NotaryPublic- ate of Florida
( g ) ( g )
Personally Known OR Produced Iden_tif' a-ion ? Personally Known OR Produced Identification.
Type of Identification ----.4, ti,opmi Type of Identification
Produced
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_:= Li\SA"rProduced
t'' . ,.° aY-`'"el s otary Valle,-State,121,2018 T _ -� . .�a. .
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Commission No. j.s 1-. AW,t;�My Comm.riles
177249 Commissiof ,Nov,,"',„,, : ^LASHU;HNA IIlGRtIga .
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;1-Y Commis§ otary Asan. I ;_, ,`�; Notary ruolic State O
r N ,nal N °� �} 18
''%:re of F�°¢'s Bonded through ati ,a :My Comm.expires Dri_ec 20,2
,,,'rF „`°' ndedt h tionalNotary AIM
REVIEWS FRONT ZONING SUPERVISOR PLANS VEG� X�7�f � �tR:-!,• - ?NGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ley. 7/2014