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HomeMy WebLinkAboutUntitled • All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: L/40E-' d7.33 Cat UNT' F L D R e rs .P. --- Wj• , F®. flIT Building Permit Application;fr Planning and Development Services y`'<<,��we _ Building and Code Regulation Division Cod 4j�t , 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X PERMIT APPLICATION FOR: i PR@POSED°INPR®VEMENT,LOCATIQ:NI' ; aRJ,w'. ' .,.4.„' , .._ a.`�, ' . -: a Address: ��� G7o ,k • � Pt. �� ,�C.@� ��L 3 z/ '(5 Legal Description: PrrAl 21) ,.• 2. 3O`i "Z Z.I - 00/ 1 T( QQ 7 Property Tax ID#: 2 30 7- 2, 7-1- 00 1l 7 00d- 7 Lot No. Site Plan Name: G ,V/✓J /C ! I La S -. c9 4' 3 Z A OD LLL Block No. ' Project Name: Setbacks Front Back: Right Side:: Left Side: . DVAILDBEACRIPTIONyt ORKQ ..k . ..1: 1W /c ce_ - (.4.),IncinwS - /- 5 t o /74>/ly `T. x 50 , / - .5,'T/Q.. //tinj 5.3x39, • CONSTRUCTIO . [ F®RMATIONo r: . ..,..;;1 " Additional work to be performed under this permit-check all that apply: _Mechanical -Gas Tank _Gas Piping _Shutters • . ,X Windows/Doors, Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: 75,..5- c./ 55c/ Cost of Construction:$ iB�-00 Utilities: _Sewer ZSeptic Building Height: O .OWeNER/LESSE° ,. ; i . ' ; C®NTT©R° ... s Name _•Y • �'".5 �� U� �GL Name;>.: fc.;�M. j4.� / Cede Sf' �C J vcks. Addrss: 970' .c 'ihc , ' Cgmpany 65SeL/ (Le//:y City: vier) tec G k State:/:"'"L'L Address: ''°f 0r- 15octizApi. Dv Zip Code:3 Z 7a 6, 3 _ Fax: Cify: - Ve-vo Jam' c 4. State: re- Phone No. 7 7 Z - `Y _ OF G 2 Zip Code: 316'3 Fax: E-Mail: t'�.3CQ ZL co Ila eA,Q 1. C ova-, Phone No7 7 2- - G L -634Vt 7 Fill in fee simple Title Holder on next page( if different E-Mail_ V't/SS lie//I/f f e 0.,1, Gri — i from the Owner listed above) State or County License C R C I `J 5I7 - li If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. EC:.1113011K/fENTWORITIMT101\fLIBN LAW INFaRIMATION • `, DESIGNER/ENGINEER: ,X Not Applicable MORTGAGE COMPANY: X Not Applicable .. Name: Name: Address: Address: — City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLEHOLDER: 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 recort ing your Notice of Commencement. __A , ii4 Signature of Ownerdb./Contractor as A ent for Owner Si nature of Contrac" for LicHolder gg g / STATE OF FLORIDA , l/ STATE OF FLORIDA COUNTY OF 7'li ✓e, e- COUNTY OF 'Irnd I 0 0 121\)iv' The forgoing instru �p wa acknowledged11 fore me The forgoing instrument was acknowledged before me this p'1 Y day of 1w/ __ ,20/j' by this?_,St"'lday of IVB CLL , 20j by 6;2,,...,,c L-... 7 uss-e_11 J. 14-•e 11 y (Name of person acknowledging) 7 (Name of person acknowledging) otaryPublic-State Flori it, of NotaryPublic-State of Florida ..,.___,, ,,/' .A.---...---.===k )1 6--()----2-4—(A---' (Signature ( � ) Personally Known OR Produced Identification Known j OR Produced Identification Type of Identifi tion Type of Identification Produced tL- j) /-- Produced_ _ - -� --- - - votes. ,•�P;;Y' ,�oWAAflDLDAY I ��° CHI�CCIIA A.SOLANO Commission No. =Z'"-„• -�,,.`��'e Nota �M-State of Florida I Commission No. MY O MISSION#FF192076 • Oof( •�•: Commission#GG 120290 I EXPIRES:January 22,2019 .."-.`"47,i'”t o i My Comm.Expires Jun 29,2021 �;;,`;: Bonded through flationalNotary Assn. `. REVIEWS FRO —v''LCrNTIVS—_SrJf'ERUTr(3R PLANS . VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/2014