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HomeMy WebLinkAboutPermit Application 4180 N A1A 203BAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: t — ai - � Q Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 452-1553 Fax: (772) 4621578 Commercial Residential PERMIT APPLICATION FOR: PROPO EIS INPROVEMENT: LOCATION: Address: SL i_1 f CT l_� .� �. °�- i. Legal Description: Property Tax ID 4: 1 L, - SOLa- C1031 - 000 Site Plan Name.- Project ame: Project Name: Setbacks Front Back: Right Side: Left Side: Lot No. Block No. -i re I C tom' -For i I V -e L�-) 14 1--) 1 C) W o itiona wor c to be performed under this permit - cnecK an tnat apply: °--echanical Gas Tank Gas Piping —Shutters Electric Plumbing _Sprinklers — Generator Total Sq. Ft of Construction: Cost of Construction: $ j-� Q Sq. Ft. of First Floor: Windows/Doors Roof Pitch Utilities: _ Sewer _Septic Building Height: Name VJ I I i %t4 r I Address: P4 o. -1W6QD City: 1itd j State: k. 3 L1 `1 Zip Cade: © Flax: Phone No. 14 0-1 ~ 'I D9 - 19 I E-Mail:bi 1 k/ Fill in fee simple Title Halder on next page ( if different from the Owner listed above) Name: Fl L Company•cd�) I A(- i t fi _ QE D Address: LOrY City: Fbc-A 1'C`( � State: -E -L Zip Code: �1LJgS J Fax: Phone No -1 - Lr3Ll - ()L4CJ t E-MailC&M COOL U.l r SQ 1 0� f�I• C.( State or County License C_� S 1c) a ci If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: Not Applicable Name: MORTGAGE COMPANY: Not Applicable Name: Address: Address: City: State: Zip: Phone City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: BONDING COMPANY: Not Applicable 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 thepermit 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. Signatur f Owner/ Les ' /Cdntractor as Agent for owner STATE OF FLORIDA 5f f ` / „ COUNTY OF The forg9ing instrument was acknowledged before me this Si Vr ay of ; yJ__c_ , 20-4 by (Name of person acknowledginj (Si f��alL re of Notary Public -State of Florida ) Personally Known OR Produced Identification Type of Identifi ti n r r Erich Daniel Kra Produced Q 0 �o NOTARY PUBLI L p a STATE OF FLO Commission No. l Comm# GG105 Ws�ce 3��� E .x,xres 511712 Lav - Signature o Contractor/L'icen Holder STATE OF FLORIDA COUNTY OF � The forging instrument was acknowledged before me this ��cay of jL4-y, , 20 by , � 6 \/Cm (Name of person arknowledgin (Signatue, of Notary Public- State 6f Florida ) Personally Known OR Produced Identification3�- ,Type of Identifi ation YA,? Erieh "' erR actt ,Produced l 'F?, f�OTP,RY' PUF3LIC � + fATE OF FLORID) IDA % -7 1 '. a vrr0 GG105925 Aommission No. �, ��eal kna r l 51,M2021 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED