HomeMy WebLinkAboutInspection DocsALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Apcpliation
Planning and Development Services
Building and Code Regulation Division
230a Virginia Avenue, Fort Pierce FL 34982
none:
(//Z=1462 -1553 Fax: j`/�/�2)462-1578
PERMIT APPLICATION FOR: To Select
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Property Tax I D #: Z 3 119 - V d 0 Z. O dco /A7 Lot No...
Site Pian Name.- cSodE' Block No.
Project Name
Setbacks Fi
ont Back: Right Side: Left Side:
DETAILED DESCRIPTION pF WORK:
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CONSTRUCTION INFORMATION:
itional wo
OHVAC
10 Electric
rk to be erformed under this perr
Gas,, Tank [:]Gas
Plumbing [:]Spri
Total Sq. Ft of Construction
Cost of Construct ion: $ 1
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Piping
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OWNER/LESSEE:
Name, I - A
Address: 112.%5 un2ksc.
City:
F�_Vt,nio
Zip Code
1J
S. Ft.
Utifities:l.
s ..-�-- _ State: FL.
� �� d Fax: T
Phone No,. 7207 Z 8 7_ 8 0 2 J l
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
a pply:
Shutters
],Generator
�onv�n iNC.� 2�ccp
P46cics
ElWindows/Doors
Roof
I�
of First Floor: Endo
Sewer El Septic Building Height:
CONTRACTOR:
Name: (AIIIJ Cllt(z nal,
Company: (J //I ct M Gvll t S
WIN
Address: _271�� SSW �nd'�.q. l�vt
Roof pitch
Zip Code:
Phone No.
E -Mail:
State or
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P'..re' .5 9 (Al M iq I C'.G
a 70
Fax:
9S
County License: Cum -w Ct3OO Zw
If vale of 4onstruction is $25�J0 ar more, a RECQRDED N�tire of G�t±m�2nr�Pnr !s ran��irpd.
Stater
ant
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY. Not Applicable
Name, Name:
Address: Address:
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5
State: CityState:
zi p• Phone Zip: Phone.,
FE
S
I
MP TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
city# City:
Zip: Phone.1Zip: Phone:
OWNER/ CONTRA OR AFFIDVIT*e Application is hereby made to obtain a permit to do the work and irtstaffation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
M �! � y� /4 permi"t
I�N i� r► .� M � � n M n n � � � rro rnr e ISt.Lt3ci@C�3�it��y iilai�e5 �iG 1'2�ie52i1tatiG� ti'iat i5 gia�1tii'ig a �lViii di.it�iu11ZC L�IC CI IIl�I i ILJi1aCl L� b-.,j1A1u Li IC �uuj�CL sLriu�.�u�'e
which is in conf�ici with an applicable Hume owners Association ruesprohibitY PP, bylaws or anc�couena�ts that may restrict or such
structure. Please consult with your Horne Owners Association and review your deed for any restrictions which may apply.
Inconsideration of the granting of this requested permit, l Bio hereby agree that I will, in all respects, perform t
in accordance with the approved plans,,, the Florida Building Codes and St. Lucie County Amendments.
he work
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 your Notice of Commencement.
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Signature of Owner/ Lessee/Contractor s Agen�` for Owner
STATE OF FLORIDA
COUNTY OF .�-4-
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OL
i toren instrument was i cib r mp
Name of person making statement /
Personally Known OR Produced Identification �f
Type o f We t m f " C a. ti on.
Produced IL V n -L. 00
(Signature o�Nvtary
Commission N.
REVIEWS
Rev. 8/2/17
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A
Nf TT8 P1 USHMAN
Nolary Public - State of 4W jl- a
Florida
4 �
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ComSsion
6851
My Com
Feb 28t 2021
of 0
through Nabonar Notary Assn,
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
Signature of Contractor/License Holde
r
STATE OF FLORIDA
COUNTY OF c`�
i Tar i *ns,
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t wal a
this E o I �0() Ef�\ ,
Ir
kt ��i� r
Zoe by
Warne of person making statement ido�
Personally Known OR Produced Identification
Ty,rfip of Identifiration
Produced �`i t Vrp f � VctvI s -we
(Signatu?i�&-of Notary Public- State-""3THorida )
commission No*
PLANS
REVIEW
VEGETATION
REVIEW
DfNAH��N
Natary Public..
ida
Commission # GG 076851
iNy Co M rn, Expires Feb 28, 2021
SEA TURTLE
REVIEW
MANGROVE
REVIEW