HomeMy WebLinkAboutBuilding PermitALL APPUCA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 2-5 Permit Number:
y^ -I J:,
sSIX
o Building Permit Application
Punning and Development Services /
Building and Cadod Regula
Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: P3(e6irvinfix, 6A Vilr(a A. 349SI
makes fairt�aw &k 41 11 Lor 30
Property Tax ID r: 4 -
Sit@ Plan Natrie:
Project Name:
Setbacks Front Back:
-000-
Right Side: Left Side:
Lot No.
Stock Rz.
ED DESCRIPTION OF WORK:
aL fb( ucc -� SA-ull new LInnOA 3- s -birl
CONSTRUCTION INFORMATION:
LVJHVAC L I Gas Tank UGas
[JElectric 0 Plumbing 05pr
Total Sq. Ft of Construction:
Cost of Construction: $ 5200.0o
Piping
yrs L_JGenerator
SqFt. of First Floor: _
Utilities: DSewer OSeptic
Windows/Doors
0 Roof
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name QVC LJ9,/(�l}Q G.G{wardS
Name: ; I
1
IT
Address, (14 3 62 A ViAt(&e
Company: / r
Nnj,j IYI�i
fI
City: (�- P(f(((� State: R'
Zip Code: 3'q 51 _ Fax:
Phone No.] - "f2j(p(
Addresss:5lO 6 A `U_ l_0'fk.L spy
City: %rb- [ trc&
Zip Code: '310 ,k_S�[!�
PhoneNo_-M- 0(-+i�l�i'(
`
State:�L
Fax: 71.7--4&0-37 3`1
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above}
E-mail:6� a
kno. trp
State or County Licen e:
_
CIBC 4$18! $ Ip
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPP MEITT CONSTRUCTi ION LIEN LAW INFORMATION:
D R/EN EEP-
Name,
! Nat Appiicdble
AIMTGAGE C€O ANY:
dame:
—Not Applicable
Address:
Holder
FLORIDASTATE OF �l r` �i le/
Address:
COUNTYOF .'
u"'�-
City:
Zip: phone
State: _
Qty-
Zip: Phone:
State:
EEE SIMPLE TITLE HOLDER:
Name:
� Not Applicable
BONDING COMPANY.
Name:
foot Applicable
Address:
Type of Identification
Address:
Produced
City:
City:
(Sigratti .
Zip: Phone:
,yr"i'^+ CHRISTINE JOYCE CONWELL
Zip: Phone:
Gommissl `: Notary P�rllioc^. Stale of FIcc��
•. A GG
OWNER : Wicabon is hereby irradeto attain a permitto do the work and-instaliation as indicated.
I certify thatoo work or installation has commenced prior to the issuance of a permit
shutttsre. Please clansultwilh yaw Home Owners Assoczationaorl €einm yourdeed for any res'izictioiis LYrtecls may ably
inconsideration of the granting of this requested permit, Wo hereby agreethat [will, in all respects, perform the work
in accordance with the approved plansthe Florida Build -trig Codes and St Lutes County Amendments.
The following building permit applications are exempt frons undergoing a'tail concur enry revieur. room additions,
accessory structures, swimm ng pools, fences, wails, signs, screen rooms and accessory lues to another non-residential use
ARN'iN£ TO : Your failure to Record a Notice of Corruneincement fray result in your paying twice for
improvements to your property. A Notice of Commencement trust be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, ocutsult with lender or an attorney before
commencing Work of at:Lvi38Eti uux ivvt.ti of W4fi43tCt4iC491C1tL
,
Signature of Con€ractor/license
Signature o. Owner/ Lessee/ContractOF, "wrier
STATE OF FLORIDA � �, �rAggent
Holder
FLORIDASTATE OF �l r` �i le/
COUNTYOF 1L.�
COUNTYOF .'
u"'�-
The fo ing' ent s acknowledged before me
this day�ofSi' by
Zhe famoing instrument was acknowledged before me
ttiis2`Jhdayof_ 2(lZo by
yy�� ``20P
lvtic rt &4`e�
�_ y�i2
lIrYlf� ' C
Name of tement
name of persupinaft statifirsterst
Personally Known OR Produced IdentiFtration
Personally Known V Ott Produced identification
Type of Identification
Type of Identification
Produced
Produced
p
(S"sgnatureof i'vofar;- lie Siete of Horida)
(Sigratti .
,yr"i'^+ CHRISTINE JOYCE CONWELL
Cnmrnissi J� A '•. CHRISTINE JOYCE COIlS'2Bl)
Gommissl `: Notary P�rllioc^. Stale of FIcc��
•. A GG
.e o Ary u c - State of Florida
s Commission k GG 984701
`•.,,or Aty Comm. Expires ; 21, 2024
Aug21, 202
" orn- My Comm, Expires Aug 21, 20246ended
through National Notary Assn. -
1on2otary s .
REVIEWS FRONT Ml tlliERVISOR
PLANS Vt-OETATION SEA IURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DkTE
COMPLE€ED
Rev. 8/2/17,