HomeMy WebLinkAboutBuilding Permit Application- , t
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: CV� •Q�
. Building Permit -Application..
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4624553: Fax: (772) 462-1578 . Commercial Residential X -
PERMIT.APPk)CATION FOR: � dWing
PROPOSED ;1MMVEMENT LOCATION:
Address:
Legal Description:.§E TIPMff/TQW;AWHJP.§§§/ MG__E .
Property Tax ID #$g7 -� 1�-�99g 9997� . got No..
Site Plan Name: §PA.Ni§H LAK Block No.
Project Name: Y99FR9NT
Setbacks Front �a' Back:'��Right Side: Left Side::
DETAILED DESCRIPTION OF -WORK:
REEPLACEEMEN MOSILE HOW : OEM UP AND TIE DOWN TO COVER
CONSTRUCTION INFORMATION:
itiona work to -be, e orme - under t ispermit- ctPeck all apply.:
F HVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
Electric . D Plumbing ❑Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ Utilities:Sewer ❑Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name NH-E6V1_L9J1 QMRIPORIA iPM
Name: ER-C\WYNJ9E:
Address: 0000 SOUTH US.HWYI SyJITEE 02
Company: �1�►'Y EOLE:V�L� PM—E{NT:R;9�OR,AT'JON .
City: P'Q9T ST.• WOJ State: L
-Address: 6999 SOUTH, tW,6 J;JM, I SyJTLE 4492
Zip Code:-.64952 .. . Fax:,i77g)676`76-56
City: PORTSIT, WACME State: FL .
Phone.No.(772) 76-5510
Zip Code: 34962 Fax: (772)876-765-
E-Mail:
Phone No. 17-72)07",510
Fill in -fee simple Title Holder on next page ( if -different:
E-Mail:.
from the Owner listed above)
State or County License: OJJ 101612661132.
IIf value of construction is $2500 or more, a RECORDED Notice of Commencement. is required. II
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:.
DESIGNER/ENGINEER: Not Applicable.
MORTGAGE COMPANY: 'x Not Applicable
Name::STEVEMORS.
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone: ,(772),M&5 .
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that -no work or installation has commenced prior to the issuance of a permit.
St: Lucie'CountYy 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 l 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or -an attorney before
commencing work or recording your Notice of Commencement.
X
Signature of Owner/ Agent/ Lessee
^Signature o-Coacto�/L'i ense HoT er
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S---KAAc.i
COUNTY OF.<r•aLuLir
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this � day of -�L L_ y' zo iby -
this _ day. of TGs20 by
4 t-t, +4 ew L y [A) Yri t-
Z-- 91 c Gy YN N r
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Nota y uState of Florida)
(Signature of Notary u/lic- State of Florida )
.blic-
bl
_
Personally Known L OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No.. •��'�8';�, DORC(8 �plN BASKIN
`'�� l'Y ' DOROTHYfygA) KIN
Commission No. .� o � f,
S' T' MY COMMISSION # GG 030145
r' COMMISSI N # G 030.145
<; S: October 2, 2020
EXPIRES: October 2, 2020
off' °P�'' Bonded ThN Notary Public Undervrtiters It 9 "'���p I�tp ponce01f1N fV0Itlfy YU011G Ufla@fWf1IBfS `
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COM PiLETE