HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONPLICATION TO
Date: Permit Number:
•
fdouildiNgPe4 it Aj?plic?tid%
Plonning and Development Services
Building and Code Regulation Divisior>_
2300 Virginia Avenue, Fort Pierce FL 34982 _
Phone: (772) 462-1553 Fax: (772) 462-15789 Commercial X Residential
PERMIT AP#ICATION JOR:Window/d
1751 Copenhaver Rd., Ft. Pierce, F
scription:
13 35 39 N 148 Ft of S 302 Ft Of W 399 Ft Of E 439 Ft of SE 1/4 Of NW 1/4 (1.36 AC) (Or 445-1935)
Propert Tax ID #: 23132440001020- Lot Nod
CitPIa- Block Nol
etbac
Front*
Back: Right Side: Left Side:
ETAILED DESCRIPTION OF WORK:
Re*pla�tId or�th ��� irrct%r�do '
1CONSTRUCTION INFORMATION:
Additional work to be ertormed under this p�rmit — check all apply: • •
®HVAC Gas Tank •aGas Piping _ Shutters Windows/Doors
�AElectric :Etubing �r n , e- �� oTf� ifc:
Total Sq. Ft of Construction!IM: Ft.
of First Floor.
Co of Comet i0: 5,140 U i� L_—_I Se -A_ S tic B i i�
OWNERAESSEE:
CONTRACTOR: ..
Name Laurie Privateer
Name: Janet Milici
Address: 1751 Copenhaver Rd., Ft. Pierce, FL
Company: Natural Flow, Inc.
City: Ft. Pierce State: FL
Address: 391 NE Baker R
City: Stuart 0 State: FL —
Zip Code: 34945 — Fax:
Phone No.
Zip Code: 34994 —Fax: 772-334-107840=
Phone No. 772-334-101
_
E-Mail:
Fill in fee simple Title Holder on next page ( if different •
from the Owner listed above) •
E-Mail: Janet@naturalflow.net
State or County License: SCC 131151263 _
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/E"E n�ot:p h ble MORTGAGE COMPANY:�Not Applicable
Name: • Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip. Phone:
FEE SIMPLE TITLE HOLDER
Name:
Address:
City:
Zia: Phone:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I cer�th no work or installationOaso om e d prl a issuanccee of a p rmit.St. L' e Coun y ma <es no representithot irs antin�it will aT�th®izOlh• ermit 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 pro bit su=
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may appl
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the wor
in accorO�nce ith t e approv d pla s, th Florida Building Codes and S . Lucie County Amendments• —
The follo�riing ildil permit plic ionS relxem from undergoing full con�rren oom additions,
accessory structures, swimming pools, fences, walls, signs, screen rooaccessory uses to anotherooroesidenti—'ruse
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for —
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencing work or recording vour Notice of Commencement.
- Ima • • *'. 1 •I•• A — I
• ••
Signatur of Own / Lessee/Contractor as Agent for owner�
-
• • ••
COUNTY OF OR
Sworn to or affirmed) and su scri e e ore me otW
Physical Presence or Online Notarization
this day of &25 by
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Name of person making statement. -
Persona y nowro uce en i ica on
Type of Identification - -
Produced
ure of
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REVIEWS
DATE
DATE
COMPLETED
Public State of
' }' Donna Jayne Hall
My Commission GG 2
FRONT • S
COUNTER REVIEW
Signatu e of Co ractor/License Hy
�AT OF FL •n •
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
day 6- n 6 1 by=
Jam+ IA-, (; 2b 2 ►
Name of person making statement.
ersona y now _X o uce%%PWo
40
Type of Identification •
Produced (�,,(�
AM,�Alh-T Btl, —
ture of Notaky�lic- 5t e0 P
ri&40tary Public State of FI
• Zu7 5$ 5 Donna Jayne Hall
ISSIOn +S �pmmission GG 207
' •y a �� Expires 04/ 161202�
UPERVISDR PLANS•i VEGETATION SEA TURTLE MANGROVE
REVIEW • �EVIEW REVIEW- REVIEV� REVIEVO
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