HomeMy WebLinkAboutBuilding PermitALL APPLI BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12-120 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
T APPLICATION FOR: To Select from dropbox, click arrow at the end of line
FAddress:
SED IMPROV€MENT LOCATION:
I $ O
r, t i Pf CPJ 3L1ggS
Legal Description: 3 )ICIM
Property Tax ID #:2303",7 n - 0025 - 000 / s
Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
5USIT U 11M Raub 3 ion IN- 5Ee-11.
Alk - pm_kay� "i4- - w i illl 10 Kw kecct.
CONSTRUCTION INFORMATION:
i 1 na wor to e e orme un er t is Perm �Y - c ec a app y:
HVAC ❑Gas
_ Gas Tank Piping _ Shutters Windows/Doors
0 Electric n Plumbing ❑Sprinklers ❑_
Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ �b0 �Q Utilities:Sewer Septic Building Height:
OWNER/LESSEE: '
CONTRACTOR:
Name D 5
Name:
Addre/ss�: S3
City: Rff(GL
Company:r�
IYF��ngyV ((P fffill4 T
I OMDLVriD State: Iii
TTj(Ci
Address: -5(V5 Pr 1tMPikL f-
Zip Code: '3� O(A Fax:
City: Fb(-b—Refs-2� State: [.
Phone No. 'itAl 10 rolyt bILlcl "0(1Z2(o-
4010"
Zip Code: 3 415 i Fax: 7?a- L((a(O 373`►
E -Mail. L) (4-I3
Phone No. -T19_- L�p
Fill in fee simple Title Holder on next page I if different
E-Mail:`�y( nA fn hpn, nn to
from the Owner listed above)
State or County Licensle: C/4C 18 I S ($ (p
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
CO I—_TOR �.FROVIT: Application 8s hereby made in obtain a permit to do the work and installation as indicated_
I certify chat no work or installation has commenced prior to the issuance of a permit
St.iurj-eCcw rna�mar�t�sentat�n atasgcamntmga�willa=atlxraetlseperm holderto�r�`esnbieetstsv.�ture
vuhitlr in wiita arFy applicable dome Owners Assocratton rotes, bylaws orend ovecavenants fitatmay restrict or prohibit such
t struciwe_ Please eonsultwtts your Home Owners Association and review your deed for any restrictions which may apply
-
ln consideration of the grantmFgof this requested permit l do hereby agree that t will, in all respects, perform the work
in accordance with the approved plain,ihe Ronda � Codes and St Lucie County Amendments_
The following building permit applications are exempt from undergoing a full concurrsmcy review: room additions,
accessory structures swunrrtirig ptmts, fences, vraNs, sou screen rooms and accessory uses to another non-residential use
WARNING TO Your failure al Record a mice of Commencement may resttixiet tr paving ttaiee for
improvements to your property. A Notice of Commencement must be recorded and posted on tate jobsite
before the forst inspection- if you intend to gain financing, consult with lender or an attorney before
commencingwork or recording your biotite of Commencement=
Rev. 812117
�tiPP�€�iTr�E C€3AiSLiCiT€� %�EPd i�� �R4�Ai'fd�i:
43 �R . _ Ta€>t App4ica�te M E COMPANY: _140tApplicable
Name: Name:
Address: Address:
City: Slate: _ Cary: State:
ftp: Phone= Zip: Phone:
FEE 53MF'iE T€ii� t#43633EEt. i 3ilrsi Applicable F€i}E�#3i COMPANY: —Not Applicable
Name: Fume:
Address: Address:
City: City:
Zip: Phone: Thr: !}!tone:
Signature of owner! te�eeeiCont:actor Agent �r caner mature of Eormzac€nrJiicense Haider
STATE QF FLORIDA STAT E OF 3fEiTA r
EO�oE` �. GU,CI� �U st. (,uely
the for ng Snstnmaemtwas acknmJvledged More me The fo rmg irastaumemiwas acknowledged before me
tiers oar day of'(�- , zo 2� by this-- +Q.day of zo ?0 6y
Name of person temertt — blame of peas akirg stat nt
PersonallyKnown flR Produrarf ntdfrcation Personally tCnvwn � alt Paoduced kdenti�rcation
Type of Identification Type of identification
Produced Produced
��
{Signature of fiictary P• � of - iSignz#'�re of Notary Pu#a State of Florida)
�, v'> � CHH��TI J. CONWELL _
��r�=���m �- +...........
Notary PL�R�-State of Florida =em Cre N„tlu� cua,cr�n�EJ CONW
e,
- Commission # GG 017839 ,'a°, *�s Notary Public -State of Florida
a^ My Comm. Expires Aug 21, 2020 = . • 5 Commission # GG 017639
Bonded t rouq � ,r• xpues ug 1, 20
REV7E�5 ,#,I SUPERVISOR ' PlAfti xn ^r c I Assi.
ARiesRQVE
ti34lf�iiEtt
till%E�°
R£tdl£
liEitt
R€S€iEitV
#LEVfE1Ri
DATE
RECEIVED
DATE
COMPLETED