HomeMy WebLinkAbout%(Fields.Code Permit Doc Type All APPLICABLE INFO MUST BE COMPLETED,'FOR AP..PLICATION TO BE ACCEPTED (�( • Cl�A
Date: Permit Number: I0S.
•
Building'.Perm:it Application
,Planning dnd Development Services
Building and Code Regulation Division
;2300 Virginia,Avenue,.Fort Pierce FL 34982
Phone: (772)462-1553. Fax: (7.72)462-1578- Commercial Residential
;•PERMIT TYPE: _
!PROPOSED-IMPRO_ VEMENT.LOCATION't
Address: �5�
Property Tax ID#: �� b 3 — bZ 66 7 Uool Lot No:
Site Plan Name: Block No.
Project Name: ._
DETALLED DESCRIPTION QF WORK "
l rtw✓
•
b;er FPL—
NS INFORMATION:
'Additional work"to be performed under this permit—check,allthat apply:
_Mechanical _Gas Tank _Gas Piping :Shutters =Windows/Doors
V/ ilectric Plumbing _" _Sprinklers r Generator Roof Pitch
Total--Sq.-Ft of Constructio Sq. Ft.ofFirst Floor:
Cost of Coi
nstruction:$ Utilites: ,_Sewer T Septic Building Height:
t
QINNER/LESSEE CONTRACTOR:
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Name ,Vfi� L�or Ga,rc t"ca Name: L2 UI`ACakK
Address: :3S$ .T� I�F -J Company
City,;.PU 614- State: FL Address: ' S 0 t i Fd(�`1,�e Ck V G
Zip Code:, Z Fax: City: EO r- T r O�C-L " State: rLL-
77_z — 3.02 l2 2 J �t4 `f 7
Phone No. Zip Code:' � Fax:"� 7�2'
E-Mail: La .6;,kIf ,LM dPhone,No 7 2 Cf 6 —Q S'o.G
Fill in fee simple Title,Holder on next page_f if different- E-Mail \iv i rCr\UZ"'i i1 C -U f , (UM
from the Owner listed above) State or County License irG t b S-S- 17
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
-:SUPPLEMENTAt'CONSTRUCTION'LIEN LAW`INFORMATIOIV:" .1
DESIGNER/ENGINEER. -Not Applicable MORTGAGE COMPANY: Not Applicable
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.
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO"OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMEN M('EN�T."
"""V � LYr.,,•v'1✓J hitt
Signature of Owner/Less a/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA j STATE OF FLORIDA ': /
COUNTY OF s�'L�e COUNTY OF LU
The fo oing instrument was acknowledged before a The forgoing instrument was acknowledged befor
this day of *i L 20 7�J by,. 9 thisday of Vh,- l„ 20 by
Y'v U rhC4&/
Name of person making statement. N_m N Name of person making statement. m r�N
o� �.y.�o
J 0 (n
Personally Known._OR Produced Identifica rg a Personally Known OR Produced Identific
Type of Identification o�— ' Type of Identification a- E p
�U� om
Produced z :.1w Produced A U.-
Ot i.
In/ •ria (nf a,''f' i.
(Signature of.No ary Public--State of Florida.). , .%:as (Signature of Notary Public-State of Florida) - c
Commission:No. (Seal) Commission No. (Seal)
REVIEWS _ FRONT. ZONING - SUPERVISOR'S PLANS VEGETATION._ SEA TURTLE- .. MANGROVE
COUNTER REVIEW REVIEW REVIEW. REVIEW. REVIEW.; REVIEW
DATE
RECEIVED
DATE -
COMPLETED
ev.