HomeMy WebLinkAboutCARROLL PERMIT APPALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6 8 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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 3'20 S W Fs'r CH56' r=R CT
Legal Description:SPIVANA CL,„ . t�LA'T aNASG THece i%Ltc 4y LOT i9
Property Tax ID #: 34 aS - io S Oo g o - o 0o . 2. Lot No. -9
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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Address:/57$ /OIEmG�P2Ct2cLe
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I CONSTRUCTION INFORMATION: I
®HVAC Gas Tank
11 Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 3q'10
co
jernui —cneLA au apply:
aas Piping LJ Shutters
Sprinklers 1:1 Generator
S Ft. of First Floor: _
Utilities:cnSewer 0Septic
Windows/Doors
Roof = Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Edu,Aacf CARRvI/
Name: -e.f{ AL me, dA
Address: 37p5 WEsTCIdesTeR G -r
Company: CCp4,v A ,t TectimoLog IES
City: PO/LTS} Loclk State: re-
Zip Code: 3495A Fax:
Phone No. ahQ' Z R9- iZ 3�
Address:/57$ /OIEmG�P2Ct2cLe
City: PO/ i 5r Loci L- State: rc-
Zip Code: 34gi572- Fax:77i�.3S / Do 2i Do 2
Phone No. 7'72 33S 206 /
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:CCen.j i s/ g�Ao(. c o r.-,. co m
State or County License: CA co 58 66o
If value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENT A'" CONSTRUCTION, LIEN LAW [NF
RM1 TE®N:
�.
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF ST LV CIE Coo'AA
COUNTYOF 5-t Lz,c16 CO3t'4y
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
: E� ALmAap
Name:
Name of person making statement '
Address:
Personally Known _ OR Produced Identification
Address:
Type of Identification
City:
State:
City:
State:
Zip: Phone
Public- State of Florida 1 _
Zip: Phone:
Public- State of Florida
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
e ? Commission N GG 197984
City:
'_ Imo; Commission 8 GG 197984
Commission
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? your Notice of Commencement.
5igWre of Owner/ Lessee/Contractor as Agent for Owner
S' t e of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF ST LV CIE Coo'AA
COUNTYOF 5-t Lz,c16 CO3t'4y
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 16 _day of 1Ueuambo2 20JI by
this 1(z day of Nouem6err_ 20_11 by
SEE AL,.g_, a
: E� ALmAap
Name of person making statement
Name of person making statement '
Personally Known OR Produced Identification
Personally Known _ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
In.ji (or L,
_�Cmz;L UAL,
(Signature of No
Public- State of Florida 1 _
(Signature of Notary
Public- State of Florida
Commission No.
"�i SANDppy,y u
'
Commission No.
"tl4'; SANDRA,, L,PI
* ate o/ �lo.id�lbtrxy p�pfp
gSCo of d��a� ry Public
e ? Commission N GG 197984
'_ Imo; Commission 8 GG 197984
Commission
My Commission Expires
April 11 2P22
My Commission Expires
REVIEWS
ZONING SUPERVISOR
PLANS
VEGETATION
SEATURTLE MANGROVE
FRONT
COUNTER
REVIEW REVIEW
REVIEW
REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17