HomeMy WebLinkAboutimg20190121_11164003ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i 121 IDI Permit Number:
4' J .._
•i _
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:
Property Tax ID #: 14}23' $O -I— 0023 - 000 - to Lot No.
Site Plan Name: Block No,
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Nt wlll supply and install new 50 gallo>1 etee.t-ri c wa i-er
htat tx—
CONSTRUCTION INFORMATION: III
0HVAC G s Tank
Electric LrJ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ I r 0 010. 0 O
Gas Piping IJ Shutters
Sprinklers 0 Generator
Sq. Ft. of First Floor: _
Utilities: Sewer E]Septic
QWindows/Doors
Roof
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name,9ttVP,n 41AnQtllAName:
�N/
Address: 3'1 #
Company:80 i-Ylern 1vMjnnl Anc-
Address: 6061 4 e /k V P Yl Qe, J
city: Fn Y i- P i P. r Oe- State: FL
Zip Code: 3qq A DI Fax: N At
PhoneNo.SjlrJ-CISS -1233
City: VV(0 R ea C Y1 Stater
Zip Code: .3201Lo0 Fax:'1-12-01-IA-01'b'3
Phone No. ]12 -5 U q - Io DI F) 0
E -Mail: N I A;
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: 1 a
State or County License: Q tool -1 �Oo
•• •�•�_ �• •� a..w — mv, e, a ncwnucv nvuce or wmmencemenr is regmrea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: — Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
whlchcis In conflict with any applicable Home entation Owners Asssociationiru esabylaws or anScovenantss that build
drestrictborprohibit 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 first inspection. If you intend to obtain financing, c9.PSplt with lender or an attorney before
Lessee/Agent
STATE OF FLORIDA
COUNTY OF
The forgoing instr11ument was acknowledged before me
this %L�dayoft/anVar� , 20aby
STATE OF FL
COUNTY OF
The forgoing instrument was acknowledged before me
this � day of � ;J VJ V . Y 4 20 19 by
�Yain'Noblev Praia MC)Wcy
(Name of PJrson acknowledging (Name of p on acknowledging )
e of Notary u irr a e rid
o Floa) 4(Sigeof Notary Pub ic- a )
Pers ally Known (// OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No, G -IC -t 1-1-1'L5 ( rt 1 ^YI"
--� $di'ea�o(ary Public Smte of Flo ides ISSIDh NO.C-IC�1"1"t25tp �..„(.e lary Pubtic
Kristin Kylie Wehh ?� Kristin Kylie
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS