HomeMy WebLinkAbout5331 Montego Cir permit package.pdfALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: %/t%c� Permit Number:
•
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
23W Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
0GeG n �2Se) r�
Property Tax lD #
I a 2-
�>r
Lot No.
Site Plan Name:
Biock:No.
Project Name:
Setbacks 'Front
Back: Right Side:
Left Side: .
DETAILED DESCRIPTION OF WORK:
1201Z#6 /
cA S fOcn� ��'
M f< eY
CONSTRUCTION INFORMATION:
itinnalwnrktabanertormed under this Dermit- check all that apply:
OHVAC LJ Gas Tank DGas Piping
9Electric F Plumbing OSprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 12 Z L . 0 0
Shutters F� windows/Doors
Generator 13— Roof Roof pitch
So. Ft. of First Floor:
UtilitiesSewer {Q Septic Building Height:
OWNER LESSEE "
CONTRACTOR:_-.,
Name JU
Address: 3 � - �A_ 0 f-, _�q _e}
City: State: L
Zip Code: Fax: �--`" �6 - 05 �1 -
� � � � � �
Phone No. 71 _7
Name: 1ri t G oU�v��tlV
Company: rt v fL y A
Address 35 b 4 o n4—an ec l& ,A, V O
City: �o r- •t- F eft_,e State• �L
Zip code: 3gg4-7 Fax: 772-g66 05L
E-Mail:
Phone No. 772- cf � b- 050
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: \TAV4 + Ce it U+z i A r- 0 N 0
State or County License:
if value of construction is.52500 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:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE MOLDER: ` 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 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 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 tender or an attorney before
commencing Work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA C STATE OF FLORIDA
COUNTY OF �Lic i 9, COUNTY OF S': Luc; G
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ay of M CL C C . 20ZL by this j ay of M ('FC t.. 20,E by
Name of person makingstatement Name of person makinsdtatement
Personally Known il' OR Produced Identification Personally Known ice _ OR Produced identification
Type of identification Type of identification
Produced Produced
(Signature of Notary Public- S
to of Fi^*ice+ - —
(Signature of Notary ublia-
4, Flin
No a Public State of Fiorid
Commission No. �
NotAry Public state of Florid
C A Woolley
ommission No. ��� 1=
` kris Woolley
mission
My Commission
11�1 HH 229552
lilt�9552
EXp. 2�E6/2026
Exp. 2/26/2026
REVIEWS FRONT
ZONING SUPERVISOR
PLANS VEGETATION
SEA TURTLE MANGROVE
COUNTER
REVIEW REVIEW
REVIEW REVIEW
REVIEW REVIEW
DATE
DATE
COMPLETED
Rev. 8/2/17