HomeMy WebLinkAboutApplication, Lindsay, Fort Pierce.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
P/onin g c7nd Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34-982
Phone: (772) 4 -15 Fax: (772) 462-1578
PE
RMIT TYPE:
Permit Number:
Building Permit Application
Commercial
Residential V
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PROPOSED
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IPVIENT
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LOCATION.
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Address:
Property Tax 1D #:
Site Plan Name:
� Project Name: 1-� Vf �
DETA
ILED DESCRIPTION OF WORK:
r-)l 1-ir r9 (Y.1 rn. rAlre
Lot No.
Biock No.
i CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -- check all that apply:
Mechanics! � Gas Tank � Gas piping � Shutters � Windows/Doors
Electric
Plumbing
Total Sq. Ft of Construction:
. :!:�cc.
Cost ofConstruction'.
OWNER/LESSEE:
Name C � ]►1r
Address:c;KokQ
city,
Sprinklers
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Zip Code: LA il Fax:
Phone Na. I I'D -. yiC.> L4 - I CD
Utilities:
Stater
Generator
q. Et. of First Floor:
Goof Pitch
Sewer - -- Septic Building Height:
CONTRACTOR: '
Name:C
Company;
Address:
City- r _1�� CQCL I
I -;-2cl 2 Fax:?_�;z
P C 0 d e: 5
E - ICI a a I - --- - -.2 Y_ k!�i
Fill in fee simple Title Holder
-
�ffr E-1i1��
next � � if
�
from the Owner listed aboe___S �C�
ve) tat�� nse
If valuef construction
t1 - $2500 or more a RECORDED Notice of Commencement is required
If value of HVAC is $7,500 or more, a RECORDED Notice of omm ncement i required.
State: F---- L
3�J�b-�ei9Jto
K.-All X
Cory"N
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:�����������������
DESIGNER/ENGINEER: Not Applicable
Name.,
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _Not Applicable
Name.
Address:city State.
Zip: Phone:
FEE SIMPLE TI'TLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: _ Name. -
Address: _ Address:
city Cit Y.
zip:. Phone: --.. Zip. Phone:
OWNER/ CONTRACTOR AFFIDVIT-on Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work ar installation has commenced print to the issuance of a permit.
t. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which 'Is ire con list Mith a ny a I ica ble Dome Owners Association ru Ie , I� Ia or and r-o enant that may restrict or proh i knit u h
p our deed for any restrictions s which a apply.
structure, Pleaseconsult with your Home Owners Association and ree
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 fro rr undergoing a
full
concu rrenc review: rooter
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 F COMMENCEMENT MUST 13E RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FIN N CI N Y CONSULT
WITH YOUR FENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." ---
Signature of Owner/ Lessee/Contractor as Agent for owner
STATE OF FLORIDA,
COUNTY OF )rev r-��
The forgoing instru en�t was acknowledged before me
this �=day of f� rT`' � , 2Q;� by
Name of person making statement.
Personally Known OR produced Identification
Type of Identification
yti�r+trEDWARNIMENEZ
Produced VL ()
ff+���i li1145,
(Signature -'of ry Pu ic- toe o
Commission No. (;q 10
R EI EW
DATE
RECEIVED
DATA
CDMPLETED
Rev.2j7j1-9
FRO T
COUNTER
ota ry Pub his -- State of Florida
Cornmission # GG 10 150
y Comm. Expires May 16, 2021
or�Tdla
(Seal)
ZONAG
REVIEW
REVIEW
� SUPERVISOR
Signature of Contractor/License Holder
STATE OF fLOR91,
COUNTY OF e✓Cr-✓CJ
� The forgoing instrument was acknowledged before me
this _� day of 0c2re&3020by
CA, (:k Q
Name of person making statement.
Personally Known _R OR Produced Identification
Type of Identification Pr F,S, 695.03192.
Produced
CLERK, P
SGott Ellis,
rich
(Signature of Notary Public- State of Flar
Dale Lough
Commission Na.
PLANS
REVIEW
VEGETATION
REVIEW
SSA TURTLE
REVi EW �
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MN I �NDili,
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a
or .
qui`'
MANGROVE
RENEW