HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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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:
Commercial Residential w
PERMITTYPE: °rvt,i�( /eJ S,cl _d-) 41
PROP.®SED MPROVEMENT,LQ(ATION
Address:
Property Tax ID #:%� -'t-� ' Lot No.
Site Plan Name: +� ' /3, &: z 6 Block No.
Project Name: 7� ,f.itA. ; �� L ' .,v s, !!A-
Additional
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Additional work to be performed under this permit — check all that apply:
Mechanical _ Gas Tank _ Gas Piping Shutters
"bectric v"Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 0
_ Sprinklers —. Generator
Sq. Ft. of First Floor:
Utilities: —Sewer Z Septic
`� WindowsjDoors
Roof 6//2— 2 Pitch
Building Height: r
:OWNER/LESSEE _ �
S �
CQNTRACT®R , j f 5
Name R,e-vlCL-- O d.e (� cs<�eea��c�_.�cs_ (
Name: e,1,\ i-% _ !1A`- f i� c®
Address:�F ° c , ' c�,� ', ral h"'? •A���3: /
:Company: -Re_ in;i_=f
Cit i � i
y: I ,° a State:.w-.
Zip Code:` -'6, Fax: °77,? -�,;�_i L.
Phone No. `,` Z)%-Li--'Qj
•� ! '1 �
Address:. (�L'
City: State: ria
Zip Code:'• /.rr j Fax: `_ 7,J" -- U
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Phone No •�'�t�-- e'_� ;�,:1 ��•� G 7�'=
E-Mail: i`t�� t �� , ,_ �.
,: e.;_. �-... r�nE;��s..;,,�a_:�:r'.z.€�i
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail /6-m X11) P, ie
State or County Licenseala Ar2_/� f
It value of construction is �25QD 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.
tJPP.LNTAL;NSTRt1ILI,:.,1RP+TIN:
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 AFFIVIT: 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 Count makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Assocition rules, bylaws or anscovenants 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, wails, 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
rnmmpnrings work or rocordine your Notice of Commencement.__
f
Sign ure of Contractor/License Holder
SignatureW Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF `5 (_G :j
COUNTY Of .
The forgoing instru ent was acknowledged before me
this � day of s v� 20 A by
The forgoing instrum nt was acknowledged before me
this '- day of {��� , 20 A)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
}
0 '.— J
f
"' Y
(Signa re of Notary Public- State of Florida j
{Signature of Notary Public- State of Florida j
OgPaV P�BIi RNO�ASt�OWE
Commission No, a : "'•. o CommissitineNG 104656
�aRVPfJg NDAS ROWE
Commission No. _ ..., �,� {S
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Expires May 19, 2021
N�91
Commission # GG 104656
Expires May 19, 2021
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ISFY 684086
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
M F-
SEA TURTLE
-
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
_F
I T
COMPLETED
Rev. 8/2/17