HomeMy WebLinkAboutPermit Application 4007 N Hwy A1A Coldwell BankerAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ::I I ls- ( � Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 3498.2
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: °—}i co -1 r) Hw�_/ rt 1
Legal Description:
Property Tax ID #: 0 13 -1 1� Lp
Site Plan Name:
Project Name:
Commercial Residential
Setbacks Front Back: Right Side: Left Side:
Lot No.—
Block No.
D.. S 1 LA f` LU Imo, \N
Mechanical Gas Tank Gas Piping Shutters , Windows/Doors
Electric _ Plumbing _ , Sprinklers _ Generator Roof
Total Sq. Ft of Construction:
Cast of Construction: $ a fa CX) °U
Sq. Ft. of First Floor:
Utilities: Sewer _ Septic Building Height:
Name - IU 11 C 1?
Address: ti DCII �S �-)i l U
City: CLY1 State: PL
Zip Code: fl+-- I J u Fax:_1_1Q - ,5H 1
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Pitch
ivame: i,,r
Company:I AA I l)t:E of FL
Address: (.L'90I ) CC',� LOCIE -
City: -Ce St��arrt�.e:__
Zip Code: f L49 �J Fax:
Phone No `1-1 2- LQ3Ll - Q(-19 I - —
E -Mail CmLaI< i]1 _ I1 •C��L
State or County License [ C noo qq.L_
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
������#I�S�'I�iJCT6�l� LIEN LAW INFO�iMATIC7N` � � � ,
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Applicable
_Not
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.
L c-�L
Lvdya_
Signature Owner/ Lesse on ractor as Agent for Owner
Signature —of Contract r° u e Holder
STATE OF FLORIDA eSTATE
5y ZVC1_1i
OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrume t wa acknowledged l efore me
The forgoing instrum nt w as acknowledged/fore me
this L day of 20Jby
this 2- day of 20jZ by
(Nameofperson acknow edging )
(Name of person acknowledge g)
(Signatur Nota " Public -State of Florida }
(Signature of Ne0y Public -State of Florida 7
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification y n Woody Uiysse
Produced � `&ARYPUBLIC
Woody Ulysse
Produced 1;/ri COTARYPUBuC
Type of Identification*xpirea
fP ,
x I�TATE OF FLORIDA
Commission No. � 6 r l ,%m(Sa#ag);197907
TATE OF FLOPJDA
Commission No,G� I97 GG197907
+
Expires 3/19/2022
3/19/2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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