HomeMy WebLinkAboutStashluk.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPIED
RE-`.`N_-TEx=:D I @ I B ( ---
Planrling and Development Services
Building and Code Regulation Division
Permit Number:
Building Permit Application
Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
Residential
PERMIT APPLICATloN FOR:
PROPOSED IMPROVEMENT LOCA"ON:
Address: 87\Sf)SC)nRr]i n ev thl &3L3
property Tax ia #: 3S2>S` G3 CL Csodrcae~C~j Lot No.
Site Plan Name:
Project Name:
Block No.
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION I NFORMATION :
Additional work to be performed under this permit -check all that apply:
Mechanical Gas Tank Gas piping Shutters _ Windows/Doors Pond
Electric Plumbing _ Sprinklers Generator Roof
Total Sq. Ft of Construction:
Cost of Construction: S
Sci. Ft. of First Floor:
Utilities: Sewer _Septic Building Height:
OWNER/LESSEE:CO\NTRA cTori:aName ts+nf=h \ I lk' Pri /h^e3}\ `'+ ( .id I Name. ,i i ` --'
AddressT *7LE+in`j. S .-Cke^ un . + I fai3 com .``J}~`./¥ fas' f3ih-1 I ; * 9t a / I
cityL`far`L=en 8ez3ch state: fl Address:(-i:-8 \j,ii-?).!%/FT Th`gived
Zip code:2ENq`S7 Fax:
:,i::.dti¥=Ji€j#+ Fax: 'State,ELphone No.q'la-' +l b-37 8q E,
Mail:ph N i-i.=j ,. a- , G="`,.t=.``
Fill in fee simple Title Holder on next page |if different E-Mail J>.izfSf3 ; )nr=.id€:. f.~" e#¥}Cfe£\ . ff%j!\vvy=\
fl.om the Owner listed above)stateorcountyLjcensetti,A,a_,5>€j:3,`574L
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If value of construction ls 2500 or more, a RECORDED Notice of Commencement is I.equ]red,
lf value Of HAVC ls $7,500 or more, a RECORDED Notice Of Commencement is requlred`
SUPPLE`MENTA`,LCONSTRUCTION L[EN LAW INF ORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name:Name:
Address:Address: \ I, A
City : `,f\ ,~ state:City: ."\` (/ j'\ State:_
zip, i RTqnel~J\¢-zjip.._ryINne..RE
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FEE SIMPLE TITLE\HbtoE R:-' Not Applicable BONDINGCOMPANV: i' y LNotApplicable
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.
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ln 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 Flcirida 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 T0 OWNER: Your failure to Recof.d 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.
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Signature of Contractor -or -Owner Builder asatpplicable
§tAUTf£FOFFLOL¥EA ( L# ri` e
:hTso]Z:3tdoaryaofff,rffiL,fTFf#cr,bed£;:;;;;;#e of bz,hys,ca, presence or on,,ne Notar,zat,on
K\M IJ)Ill
Name of person making statement.
Personally Known ' OR produced Identification
Typeofldentificati Pr duced ~
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATERECEIVED
DATECOMPLETED
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