HomeMy WebLinkAboutShehata permit app & DiagramAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
U N T Y.
F.`I. a R I g A
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 TYPE:
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial ✓Z Residential
Address: tO (0 D C_ '_ A^ -A Sa 16Q,
Property Tax ID #- s 1-) ,, b 6 L) -, cl Lot No.
Site Plan Name:
Project Name: �)h e�leki�
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Block No.
Mechanical _ Gas Tank _ Gas Piping
_ Shutters
_ Windows/Doors
Electric — Plumbing _ Sprinklers
Generator e
Roof Pitch
Total Sq. Ft of Construction: _ —2 t)
Sq. Ft. of First Floor.
Cast of Construction: $ 0 Utilities: _ Sewer Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name M
Name: Rwtf , J� r►3
Address: u ;s_)
Company: &:D G ;, {
!✓� ti ��L
City: State: IC(_
Address: 67
` cZy p�
Zip Code: 3' Fax:
City: S r'
State: tiLlL
Phone No. `ra
Zip Code: 3 yy!LZ
Fax:
E-Mail: �__- `r!
Phone Na__
Fill in fee simple Title Bolder on next page ( if different
E-Mail_;1 �, p 10
�1
from the Owner listed above)
State or County License
CvQIQ_ ,�_ L ILce-7
If value of construction is prnn nr -n � Drrnonrn a ..:_ _.9
_-- -- ,+Woos vE a.wrnnencerrient Is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
WEER: Not App
Name:
Address:
City:
Zip: Phon
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
V4Y IV CRjr %.LJJY, rVJI.I UK AI-t IiJVI I: 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 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 COMMENCEMENT."
5ignatu wnefr/ Lessee ntractor as Agent for Owner � Signatures ractor/License Hnl
STATE OF FLO STAE OF FLORIDA
COUNTY OF C'i.} ► n COUNTY OF 1�1
The forgoing instrument was acknowledged before me The forgoing instrument was acknowled �ed` before me
this Lt day of frl h 2t: by this+% day i1G�} 24F by
ga'n'j Ll ID [ l 'r- i y-A,
Name of person making statement. Name of perso making statement.
Personally Know OR Produced Identification
Type of Identification
Produced
Peru Known OR Produced Identification
Type of Identification
Produced
1*
--Gla-4 2k QCln t
(Signature of Notary Public_ State of Florida I (Signature of Nota
Commission No, *�'- DANIELLEZI I I _""� p" DANIELLE ZIELINSKI
Commission No.
mission 98121 :,: commission 4 09f81t721
Expires October 13, 2023 ` o= Expires October 13, 2023
p' p = Via,., yoQ:
REVIEWS FRONT ZONING --]'SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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