HomeMy WebLinkAboutPermit Application for 4180 N Hwy A1A 605BAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - � _ f K -- Permit Number:
Building Permit Application
Planning and Development Services
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:
Address: L4 l Ko A a
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
- 0�" Q 0
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
L--fvrechanical — Gas Tank — Gas Piping —Shutters _ Windows/Doors
Electric Plumbing — Sprinklers
Total Sq. Ft of Construction: .-1
Cost of Construction: $ COO- (30 _
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities
Name CA 1 I I A -W 1&.3-4 J IL. T
Address: LI I Ko Alit os
City: r I IfI rCE State: el—
Zip Code: 13 9 Fax:
Phone No. i i - L
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Sewer _ Septic Building Height:
Name:"':'_ Y�
Companyt�aDl 1-'t► f 1�► U 4 1t�1 FS u► fes- , -
Address: qo3 fLhoca Looe
city: } l►e"State: (r o
Zip Code: JL CIS Fax:I -w.- KCA ` S Y-) Q
Phone No7-12- L-03�-� " (L)Y 9 1
E-MaiICOO i (_:►I r rrn, I, Wm
State or County License 4 g t C) 09
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LEN LAW.!NF9M�T Q :
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 our Notice of Commencement.
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Signatur f Owner/ Les/Cdntractor as Agent for Owner Signatu re-oJ Contractor/U en Holder
STATEFLORIDA / CTOUNTY FLORIDA
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COUN OF 7
The forgging instrument was acknowledged before me The forgging instrument was acknowledged before me
-by
this ay of '3L _ 20,_U by this V d of f+ 20A by
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(Name of per n owledging } (Name of person a nowledgin
(Signa re of Notary Public- Stdte of Florida } (SignatuP6 of Notary Public- State 6f Florida }
Personally Known OR Produced Identification Chi Personally Known OR Produced Identificatiori��.
Type of Identifi ti n , / Type of Identifi ation A� i-rlch amp rac
Each Daniel Kral"h ;.? N Ti i Y PUBLIC
Produced /f�{Z 1ARY
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Commission No. L� -STATE Of FLO -IrD�ommission No. ' e�n'rt'.#GG105925
? Comm# GG105 z5
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SAN i � E-..xpireg 511712D21
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014