HomeMy WebLinkAboutUntitled f
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 190.7 2-c1
rliiii.._.L OR 1 D_-n MQY
Building Permit Application , 4.9 los
Planning
and Code Regulation Division e§L(4n jg a coy
Building -nt
2300 Virginia Avenue,Fort Pierce FL 34982 •
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential y
PERMIT APPLICATION FOR: To
To Select from dropbox, click arrow at the end of line
',�'J"mu�#'t+s�rJ2�•Y"M�'9 +����""o-f; 1�1,si�,�aT�- s+:,� t 'R-. .Ca. �.srk. �.'�#V et.y�,r. <y. 'ri2Y ads -:1"-.:":-':.-44----' .
PRO,PQSED3IM!P�ROVEMENT LOCATION
�,„ ' DKV- N :';'''1-'''u: tl
�,;Rr�u. � *« r ..
Address: 03 I Cary\par‘-‘‘.\ x �-‘-' e1Qra_, a. 3c-0SI
Legal Description: 5 pan-,51, Laices FCuYwcL 1341 3Li t 1 3 609(0",344)
Property Tax ID#: /3ci(0 5O0 -0?5(0- 000-t.o Lot No. 3 ccJJ
Site Plan Name: Block No. 59
Project Name: 12\0J H 0..CsQ..a0cn
Setbacks Front Back: Right Side: Left Side:
`-
° ` ,DAILEDDESCRIPTIONOFWORK • �s,,', , ' ' >,, -
° .
7,,,:v.,-,--.8-A.,,,,,7 dltisro ryw to ,- . a,' Y:t � 1I,i , : M
SocAtZ A`T-riG F (
T". Si F''}. iG 'a6 �t�5 � jetirt R` ,'`u t.' . Pw� 4?Ar- v ,-. tx a 'tS
N�SaR�IJCTI�O`N INS-ORMATION � F r �
' `� � �f�a ..x. 1....�.. t�s.��,
Additional work to be performed under this permit—check all ha apply:
HVAC _Gas Tank Gas Piping I ' I Shutters l Windows/Doors
ElElectric ❑ Plumbingli: Generator I Sprinklers _ I Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
00 n
Cost of Construction:$ 1 t113�. '-e� Utilities: _Sewer I 1 Septic Building Height:
`OWNER/LESSEE ;'' CONTRACTOR: '
Name 'RocNer Ncugedocr -. Name: 'Robes--N- 71'01\aeK
Address: V13% C0..cr.ear,i1\G. Company: So LAR... EnelrcL Sys-kerns
City: ck . pl 2r State:FL Address: i b0 5e•-1allwocd ,re.
Zip Code: 34 q 5 I Fax: City: c+ PieXC.C_ State: ELL
Phone No.112.-332.' gz2-9 Zip Code: suici L. Fax:772-`-1l0L'-7 737
E-Mail: ` - Phone No. 772" 46,4-2Io(03
Fill in fee simple Title Holder on next page(if different E-Mail: 5m 5c'I c"..(e-ners 5e L a�oo.coag•
from the Owner listed above) State or County License: CNC. 0 S6631
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
aE ACiOtaS 0171LEAUN r rAT'+e�•I , : < $ffe,
° . " Mt� .
1. a
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.
I
' I • I � 4C /. • ✓
Signature of Owner/Lessee •ntractor as Agent for Owner Signature of Contractors - se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5+ Lca 2 COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 26" day of M cL ,20 121iby this 25. day of Mow.3 ,20 ISS by
r J Derr 2,_ca_\\ace_ '{ges (* z«\\ctcl
Name of person making statement Name of person making statement
Personally Known ,/ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
y�/�icvLc o. /,�Qan u� ,.rs2 ////) Q� l
(Si nature of Notary Public-State of Flo '•- Marie Sarah Music (Signature Notary Public-State o L z Mate Sarah Music
, NOTARY PUBLIC NOTARY PUBLIC
Commission No. 'FF-712.)37 �' STATE OF FLORI6Bmmission No.FFq/2137 :ri1, ATE OF FLORIDA
FF912137 • "::'' Carve#FF912137
' ExpiresC8/24/2019 Expires 8/24/2016
REVIEWS • FRONT , ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17