HomeMy WebLinkAboutBUILDING PERMITAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
I _'_ L
�01
�=
Building Permit Application
Planning and Development services
Building and Code Regulation Division
3 00 Virginia A ven ue, Fort Pierce FL
Phone: (772) 462-1 5 Fax: (772) 462-1578
Commercial D� , Residential
PERMIT APPLICATION FOR: Ic tv I k.-4c
� PROPOSED IMPROVEMENT LOCATION:
c1d r ss�, 'S
r
Property Tax I
Site Plan fame: H0-70t-%_��ff
Pray Name:
DETAILED DESCRIPTION
Ac
1pl� 000
%rr
12.. d.
Lot C
310ck No.
New Electrical Meter Second Electrical Meter
I CONSTRU ION INFORI'111ATlaN:
Addi-tianal work to 6e performed under this permit- check all that apply:
_Nec�zanical ,. Gas Tank `Gas Piping _Shutters
� Electric
Plumbing
M.....
To to l Sq. Ft of o nsVun
Cost of Constru cti o n : co
OWNER/LESSEE:
Name rl, i
Address: �. Z vl. /✓✓J (—�tx Ci ty: P'YL
Zip Code:. 5LIci pk7
Fax:
� Phone No. j lamZ - 'I J';' ._
E-Mail:
Fill in fee simple Title Hodder on next page ( if different
' from the owner listed above)
` Sprinklers
State:
Wind ows poria
Generator Roof PIt
Sq. Ft. of First Floor:
Utilities: Sewer Septic Suild'ing hey nt-
CONTRACTOR;
Name: jk)j/)L4o.A C,ifl
Companmot1,%
` +A �
Address: .
city: to .
Zip Code; Lji Fes:
Phone o ', - w
E-Ma'11 (-&.1LSC- (U L V" A
State or County License t-- C I ic2o�-T-r
If value of construction is 2500 or mare, a RECORDED Notice of Commencement Is required.
If value of HAVC is $7500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name:
�i Address:
City: State:
Z-1p: Phone
FEE SIMPLE TITLEHOLDER: -MMENOMMEWNot Applicable
Name:
Address:
City:
ZiP= Phone:
MORTGAGE COMPANY: Not Aoc)1'jcab%1e
Name:
Address, -
City: State
Zip:
Phone..
BONGING COMPANY:
Name:
Address:
City:
Zi P: Phone:
_Not Applicable
OW N E R/ CO NT RACTO R AF F1 DVIT: Application is hereby made to obtain a permit to do the work and irsi.atlauan as
I certfY sat no work or installation has commenced prior to the issuanCe of a permit.
rd+ t .
t- Lucie Coun ;makes no re- prese nntion i � a
whichis in �n� �� � � ���� � r�nt�r�� � ��r it will authorize the er it hcMer, build t - �
5"Mure. Re-ri areapplicable Home Owners ssoc��tion rul � tha " �i rr
} , � � �
4� Owners Association and review your deed for an re r i n. � �r •,:,i
y.
sa ��r a��n ID,rnn of this requested Permit, � �� here
2��'`��� v�� � � ;� _bagree that I iII� In all r�, v�'x
�i a res, th a Fl orida Bull di ng Cod es a n d St Lucie Coup '
The toIlc ,ram tildiLpermit appli at,
eMPtfro munclerg 1 ng a f u I I con cu rren cy review: room a c c[jjc
ii sw,Poo I -F fe nc e s, W a I I s,signs, screen room s and a cces uses to a n c t:h e r r c r! r!,,
WARNING TO OWNER* Your
oir
Ifnp-oVefnents to your property. A Notice of0 Cc 0i %-ornmencement a in aintwiCommencement must be recorded Pn the pi cf records of 5z_
LuciQ Cc Lj n":y and pasted on the i �v�Ienderoran
obsite before the first i ns pection. It you intend to obtain ��nanc?rg, consu'
�n attorne before commencing work or record- n _your Notice of Commencement
S' a-r.z -'e � 0*'er1 L.esseeICvntractar as agent for Qwner
srArF of FLORIDA JM-
COUNTY OF � r LA
SWOP (Or rmeko,4.) and subscribed before me of
F'n)s_-c21 Presence or Online Notarization
If S. C2�0 cf I or
2020 by
C:f P 9 s72 tern a n ,
Pe �� a ' I y Ins OR Produced identification
MW
Prod jc,�ed fo.�L D LOO,
(&gnwrure of
Commission N
we
COMPLETED
Signature of Contractor/LicenseContractor/License H �� r
STATE OF FLORIDA
COUNTY OF ✓ �+ '�
Zr for ffirmed) and subschb bef -re r e
P ysical Presence or n "ll
this ( day o . 2 01[d' bi
Name of person making statement -
Personally Kno rn OR Pr y , oer ft luX
Type of identification
Producec6 VZ_(_ 0401.
SSA TU RTLE I MANGROVE