HomeMy WebLinkAboutFORT PIERCE - 8403 - PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICA71ON TO BE ACCEPTED
Date
E
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
Commercial Residential
PERMIT TYPE: -Re-- (-Cx>F Sh'ln e—
PROPOSED IMPROVEMENT LOCATION:
Address, yG3 rnz++rC�lvc�.
Property Tax ID#: 1,3G 09 - C)1J?%— C) 00 — 9 Lot No. 2-
Site Plan Name: YO,5 For f- P� erc, Blvd- Block No. C?
Project Name: FGi-J' pi'e-i-Ce - WgDS - 4Shin�il e
DETAILED DESCRIPTION OF WORK:
Te-not- -- re
F
Shia [e = FL1F3 -, _R C am1-,5hc�L = r=L /7(-/oi:~ PY
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-checkall that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric Plumbing —Sprinklers _Generator i/ Roof Pitch
Total Sq. Ft of Construction: 341 OC>
Cost of Construction: $ i 1 __q y`7
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name tU q en e �MoY /is
Name: 01,1chcre I Dru!ajalss
_
Address: ;5 40 3 Fc r4- Pf er-C -e F K,4
Company:' re?fi,92 47C
City: Fort a t--r C,o State: i L
Zip Code: 3LJ 5 Fax:
Phone No. ag -(.pW l r 150 Ll
Address: �J�f� 7-,r Gr71 7r Ci i
City: x t a CeY lG h4r— State: FL
Zip Code: .33Q a Fax:
Phone No L11-
�
E-Mai1:_0 i- i C1 ei-.q6-r7e 0n-efscgQC- Q+
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mai! 1a sS i2PS brct --h o-i 0qPiaiZf1
State or County License CSC C 1 L0
If value of construction is.525M 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Add ress:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: — Not Applicabie
Name:
BONDING COMPANY: Not Applicable
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 Dome 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, 1 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 JOR SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FWANCING, CONSULT
WffH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of . 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF -5" • Li t G i e
The for Ding instrument was acknowledged before me
this day of 1] U h e— 20jg b
�
m I c 04 E' � �C� l C� tS�
` 4
a,
Name of person making statement_
Personally known ." OR Produced Ident
cat1brr
Type of Identification
`O c' I
Produced
U; ro
U tiE -
r n
(Signature of Notary Public- State ofFlorida)
Commission No. f �/ q �� (SE
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/1/19