HomeMy WebLinkAboutPermit Application 4160 N A1A 701AAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �] - p 1 1� Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34582
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial z Residential
PERMIT APPLICATION FOR:
C MEW
PROPOSED IMPROVEMENT LOCATIaN:01
Address:
Legal Description:
Property Tax ID #; a Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
U116741IMS
ditional work to be pe
`mechanical
Electric
under this permit - check a
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ I- 9 q0C)
Gas Piping
— Sprinklers
at apply:
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: Sewer _ Septic Building Height:
Name i{C °'t 1 Name: 'n,
Address: Nipc , - l A Company: [L<n� -A1r ' Ipl U -HC) .\ DIr
City: T -�p tcr(]EP - State: _EL Address: LIDS �Gl l QrNe -
Zip Code: 3L-19 L49_ Fax: City: r ��� P tC-�L� State:-C---L—
Phone No. ZL"l � _ �9 3� _ Zip Code:t3t-I lS l Fax: 1'I aSD1-S9
E -Mail: Phone No ' -1 D -�o�t l - CAH G 1 --
Fill in fee simple Title Holder on next page ( if different E-Mai[CC70 la, (- rYC41 1
from the Owner listed above) j State or County License C l K I9
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
.
N. RW iNFORMATIIaIU
PEN�`4 CC NSTRUCTIQL
DESIGNER ENGINEER:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
a&ARYPUBLIC
Name:
Address:
Commission No. eS 6
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
E 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.
Signature Owner/ Less e on ractor as Agent for Owner
Signature'o Contract ` Li e Holder
STATE OF FLORIDA 1 STATE OF FLORIDA
COUNTY OF S !�✓� COUNTY OF
The for Ding instrument was acknowledged fore me
this day of 20y
S� r\ z�
(Name of person acknowledge g )
(SignatureNotaK Public- State of Florida j
Personally Known
OR Produced Identification
Type of Identification
y rWoody Ulysse
Produced 6tVe-05�
a&ARYPUBLIC
TATE OF FLORIDA:
Commission No. eS 6
. ,%ont 00197907
E Expires 3/19/2022
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
The forgoing instrum nt as acknowledged/fore me
this day of , 20_A5 by
(Name person acknow edging )
(Signature of N (y Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification T't.
Woody Ulysse
Produced J✓L'i��TATE OF FLOPJDA
Commission No:G� 197, 7gWGG197907
xpires 3/19/2022
PLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW