HomeMy WebLinkAboutBuilding Permit Application Dec 04 18,06:03p •
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12-14-1 ) Permit Number: i 06179
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COUNTY
‘mmainesmair 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: JCI Cs bk..1.)....-V-11.
Legal Description: ..)(3.J.,-) 0_1-1(--\ C31-thy -
Property Tax ID#: (YA- (DoLsc) - 0(DC - 7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additio - work to brq_aerformed under this permit-check all VIA apply:
HVAC I
i_Gas Tank riGas Piping I I Shutters L1 Windows/Doors
—1Eiectric E Plumbing L._Sprinklers 11 Generator I I Roof , Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities:I ISewer nSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 'P.E.-tsv2a---i- U3Ahu N a m .),A•nr)f-siA-
Address: k Co\ULM Nn\-- Cur. Company:CCUXQ LLQ,CitY: LLç&S State: U Address:ff5 LO Mr)Ot1,11-1[1 Q P ie io3
Zip Code:31+P SO. Fax: City: POO5 Lu C,Le State:re_
Phone No. I Zip Code:3 Li-QS'CP Fax: .77D ,0"."7 14750
Phone No. - t_pats ri LP 01-fr
Fill in fee simple Title Holder on next page(if different E-Mail: a;k r So{Irco L1.06tY1
from the Owner listed above) State or County License: Oa 3 \-t, _
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Dec 04 18,06:03p
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1 SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: • Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State: }
Zip: Phone Zip:- Phone: I
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 fender or an attorney before
commencing work or recording your Notice of Commencement.
G r r --�
Signatu Owner/Lessee/ antractor as Age 7R for Owner Signature of Contactor License I
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STATE OF FLORIDA _ STATE OF FLORIDA
COUNTY OF �T �tel C.U. c..--51-COUNTY OFL -
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The forging instr ent was cknowledged before me The forgoing instru ent was ac nowledg d before me
this nday of t .('J,� Q,A ,20 03 by this friday of IL g CJLI'I XP.,20 J X by
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Name of person Taking statement Name of person making statement
Personally Known l— OR Produced Identification Personally Known 1.-•--. OR Produced Identification
Type of Identification Type of Identification
I Produced Produced
_______ Jaina. CY
Si to (Signatur -PLe of Notary Public-State f F orida)
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,+'�+► III4:;;;, GENA LORENZ RUF I • _ — — �� ♦ s
Commiss- W +„��P ; 0
� ��ijnil - - c-State i4a I Commissi [�o+�^�► •, GENA LORENZ fi�Seal)I ?. i-1-,lei;? Commission*FF 957967 I 'r ,i4 ”a Notary Public-Slate ai Florida
t ���o`'' My Comm.Expires Feb 7,2020 I •
ii c�a Commission iP FF 957967 )
,�as�flr MIO,mm.E,plros f.b 7.2020 0
REVIEWS FRONT ZONING SUPERVISOR PLANS vtucn%rruier11/"SrATUR10E 1VIANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2117