HomeMy WebLinkAboutpermit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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
PROPOSED IMPROVEMENT LOCATION:
- ■ L • • W1,6410ME
Property Tax ID q: 'ZS75Z - 500- DOAA - 000 --1 Lot No. "70
Site Plan Name: Block No.
Project Name; 00-ae- JUe, ` da 2—
Setbacks
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
6toc -VO `im�aLck
CONSTRUCTION INFORMATION: III
onal worK to ae
errormea
Gas Tank
unser tors permir- Cnecx an
❑Gas Piping
apply:
In
(�,{�
j Windows/Doors
HVAC
State or County License: 'S C• 13115221-3
_Shutters
Electric 0
Plumbing
❑Sprinklers
11 Generator
jL
11
Roof
=
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction:$ -1f(411T
S . Ft. of First Floor:_
Utilities:ll Sewer 1:1 Septic
Building Height:
0 W N ERAESSEE:
CONTRACTOR:
Name (-rn-40IIUI&QMWM,5yLLL
oSt;PN V-RuS0,Vo_k!p6NT
Address: _?" whTF4r-`oau- sru
Name 5a_ (N �urnMP✓rC
Company: NAI jnew -f- ric" 'Det go (-,p
Address: 4A(61 Wi-6-11tr PertrrU Ste, 9
City: cf.RLeac - Stater
Zip Code: $A!]I,5cJ Fax:
Phone No.
City: State: FL
Zip Code: Q39 Fax: S61- 7y;' t5 3 z
Phone No. S(RI- -1 LIS - a 0IRS
E -Mail: Lit' Y'Mi1rS 6Z�l Y CUe-f (. COM
E-Mail:.ta(knnaL-- mon
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: 'S C• 13115221-3
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. L4cte County mak no represehtation that is granting a permit will authorize thegermit holder to build the subject structure
which is In con ict witisi an� applicable Home Owners Assoc anon rules, bylaws or an covenants that may restrict or prohibit such
structure. Please consult w th 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. Lude County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, watts, 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 aying twice for
improvements to your property. A Notice of Commencement must be recorded and posy on the jobsite
before the first inspection. If you Intend to obtain financing, consult with lender or an a rney before
CS
/C r
: FLORIDA STATE OF Fl
OF Sr. Lf/C/(s COUNTYOF
The forgoing instrument was acknowledged before me The f !WIng inst`rent was acknowledged before me
this IQday of OCJ" 20Luby thisW day of N1 .20220 by
GU/�iw,� �Ld✓�f 5'aStx� SumrnP�
(Name of person acknowledging) (Name of person acknowledging)
(Signature of o aryPubll -State of Florida )
Personally Known OR Produced Identification _
Type of Identification Produced
yp��;`::;;'4,� WILLIAM L GLOVER
Commission No. O0M*onNGG343330
t.,A e� EMpiresJune 10.2023
Revised 07/15/2014
vV
(Signature of Notary _Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
.www
028904
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