HomeMy WebLinkAboutPERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10 - - 7-010 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
PROPOSED IMPROVEMENT LOCATION:
Address: t3�i ?CWk(WU'M CT A> XW&Sm T _ (and FL 349y9
Legal Description: Qurpiy; c dei - ODA I�I1L I'jJ�pli
Property Tax ID#: l`l��('�101-Oktol' 00p. 2 Lot No. 1)
Site Plan Name: Block No.
Project Name: fA_10hei\ Q,momm
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
9,eA X k(v w',\dOwS -fj '7 etoorl -t-o z'mPoLOr
CONSTRUCTION INFORMATION:
�dditiona wor<to De erformed under tis permit-checkallat appy:
❑HVAC Gas Tank Das Piping Shutters windows/Doors
❑ Electric Plumbing ❑Sprinklers ❑ Generator ❑ Roof ❑ Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ l 510 .(04
Sq.cFt. of First Floor: _
Utilities: []Sewer ❑Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name�OhjLaaWGay
Name: SO,Sen !6ommet-5
Addre'fs'1s: ►iii 014- Lmegt Cr
Company: Vkn&W* Ibpar
Address: Q(oI-m%sphCC %&
[)&sign_Qcprvww
Dr• Str-. E
City: H�}G tAgp�'�glotnd State: FL
Zip Code: 3l(e(yw Fax:
Phone No. (o3I' 33`1' 4 ims
City: zs%joa r
Zip Code: SZ&4%g Fax:
Phone No. %(01- 3`d 8 ^ `'£SOS
State: Ft—
Si:(' 147-- 15?%
E -Mail: 5!r+8�ms;J . t,,om
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: P4.rMriS 15P -A
tAa
State or County License: Sa'
l
w V&mjil. cbM
1'311S LYS?
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
FRONT
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
MANGROVE
Address:
COUNTER
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
✓ Not Applicable
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 County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con lict 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 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
improvements to your property. A Notice of Commencem nt must be r
before the first inspection. If you intend to obtain financinconsult wit
commencine work or recordine vour Notice of Commencetent.
as
STATE OF FLORIDA
COUNTY OF ;T)_ LUG/E
The forgoing instrument was acknowledged before me
this�dayof OGlb/T 20l)by
STATINDF FL
COUNTY OF
It in your paying twice for
and posted on the jobsite
or an attorney before
The forgoing instrument was acknowledged before me
this day of QC>kObPTC , 2011W
1lelliziNr G. 6ioV(l— I ;Ysoo summers
(Name of person acknowledging ) - - - (Nameofperson acknowledging)
(Signature of ,Public-
� S' / eo Florida )
Personally Known —11.X— OR Produced Identification
Type of Identification Produr P°&� WILLIAMLGLOVER
Commisslon q GG 343TSU
Commission No. �. „ (�I)sJuno 10,2023
Or ROP` Bonded Thm Bedget Nnbry SeN10,
Revised 07/15/2014
W �y
(Signature of Notary Public- State of Florida )
Personally Known VPuOR Produced Identification
Type of Identification Produced
Commission No.
028W4
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS