HomeMy WebLinkAboutZetterAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ° Permit Number:
_ 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 TYPE: keok_,Le vRt4,L+ 36 6c4 c w,)4m4lf'
PROPOSED IMPROVEMENT LOCATION:
Address: 32�2-1 c4e—r-
Property Tax ID #: '3`T G -q ._70 Z _ Oo?_ - 000 7 Lot No. _/5
Site Plan Name: le-1-2 r&f�-t 0t L Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
_ Electric Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction. $ , �
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameG-'eLL�, M �£�-Icr - Ei A,icAn-'
Address: 32Z1 SCle_f- �'' 'c �
��
Name: + (XV,+TYi
Company_ l&, Vd,.�`��� VtuA,, Y-tq �t-r
City: Fc' ` T L'i c-tom State:
Zip Code: Fax: ���
Phone No 6-71-2—J -74-L4
E-Mail: 2 _4 lc_ !�J Y.4"_.9 • c-a M
Address:l5-5-1 Sc;V Ifn I�J+e-+Vl,X-u _ CAf-
City:a,I St. (-xjC_t(e_Stater
ZipCode:�(4r-i S Fax:1_70;,' >31"3
Phone No 17�2�-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail iW4, e f24LC 10 &t6t )&1 enheA -C,00
State or County License' t C 14aS
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.
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:
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
Home Association restrict or such
anycovenants that which
is in bylaws or for
which any restrictions may apply.
hpyoiur Hle
structure. Pleasecconith sult ome Owners Assoc ton and review your deed
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,
and accessory uses to another non-residential use
accessory structures, swimming pools, fences, walls, signs, screen rooms
"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 L ND R AN ATTORNEY BEFORE RECORDING YOU NOTICE OF COMME EMENT:'
Signa Contractor icense Hol r
Signature of 0 ner/ Lessee/ ontractor as Agent for Owner
STATE OF FLORIDA _
STATE OF FLORIDA!5 i LAIrc:lc
COUNTY OF � i
COUNTY OF J
The forgoing instrument was acknowledged before me
The for oing instrument was acknowledged before me
this 13f1 day of ��' fl'JCc�✓�iT_ 20 by
this day of �Fs--t �-+ 20 : = by
—
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
"of
(Signature Notary Public- State DIANE C
LE(Signatu of Notary Public- State of Florida )
r'o�" Y P�e�.'•.
y Notary Public - 3t
Commission NA: % '/ `? _ commission #t
to of Florida
F(261-A t�iiss n No. (Seal)
My Comm. Expires
Jar 14, 2020
oa Fonded �'. through Natio
al Notary Assn.
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7 19