HomeMy WebLinkAboutPermit application- Alexandre All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
II
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 a6
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential �\
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATION:
Address: %5y0 0,0119Met7�0ne. 4>r V-D-4 93%�UCL 5-_�\ 134g4!!�
Legal Description: (" An .
Property Tax ID #: a 32(0-(000 01 D y' 0 Q 0 $ Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
o �' - .\� �u.►n �� c. �`► tin d S ' Wc�1K g�+es
CONSTRUCTION INFORMATION:
Additional work to be per orme un er t is permit-c ec a t at app y:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_ Electric _Plumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ (aI (DOC Utilities: _Sewer _Septic Building Height:
OWNERAESt�S�EE: ` CONTRACTOR:
Name ei r,,0 kr' 1AArl°... Name: {Q .r'k 4One,
Address: g540 i��Ob1e5�-onc. J' Company: Yl L G
City: b'r tef'CO, State: Address: 11� '(�f S:�.J • 1�c.�C �nu..r 5�'
Zip Code: 'S'Kt4� Fax: n �City:pb State:
Phone No. &5O_ (p(Q� C)qoal Zip Code: 3 qq5 3 Fax: V1 A
E-Mail: ti I Phone No -17 a - Sod$' (V 119
Fill in fee simple Title Holder on next page ( if different E-Mail A 6 C L A 591, f1i►a
from the Owner listed above) State or County License 0 `�
JLvalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
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 AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County 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'herebyagree 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,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 our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF 5-�• Lt.C%-P-
The forgoing instrume t wa acknowledged before me The forgoing instrume t was acknowledged before me
this2� S day of v' 20_'k) by this 2 day of St 6, 20-Ro by
Q-j. 6kw%r i Sw �i�ai 2
(Name of person acknowledging) (Name of person acknowledging)
d
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known '� J
OR Produced Identification Personally Known J� OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Notary Public State of F1 i ids
� . Lisa 191a1f
Commission No. F�� 0 3,9 1 D 7 *000FL"Bairn 70MMiS 'on No.tjf� OR510'`1 t I)MYCOmmissionHHO 7
. MY COmmasion HH 7 a Expina tl8lOSI2021
Expires OB M024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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CERTIFIED TO:
1, John Robert Renschler and Cmily Marie Renschlar
2.. D.R. Horton. Inc. 11-IOMAS P.' KIERNI N, �v - A E
3. D111 Mortgage Company, Ltd. Professional Surveyor & Mapper
4. Alliant National Title inaurancs Co. 1=larldo Certificate No- 61 9
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