HomeMy WebLinkAboutBuilding Permit Application,ALL APPLICABLE INFO MUST BE COMPLETED, FOR;APPLICATION TO -BE ACCEPTED - a.
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Date: Permit Number:
Bluilding 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 dro box; click row -the end .of line pp
P o w
PRQ.POSED'I'N1PRO.VEMfNT LOCATION
Address: V-)
Legal Description:
Property Tax ID #: t�2 g . /3.L/ 1/i," O U ,.o �a., f% Lot No.
Site Plan Name: ' Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED`DESCRIPTION .OF WORK:
�2r4 6\Jr44� � o
Mc. tpNokctm 'QZ L tN� G to I.
'CONSTRUCTION INFORMATION. fir,
Additional work to . e nertormed under this permit —check a apply:
Tank- Gas Piping _Shutters a Windows/Doors E1HVAC - Gas
Electric Plumbing Sprinklers Generator Roof" Roof pitch
Total Sq. Ft of Construction: O '" . S Ft. of First Floor:
Cost of Construction: $ a, O a xO O Utilities: Sewer E]Septic Building Height:
OWNER/ LESSEE:;
CONTRACTOR:',
Name N.. V .S . ;
Name:. KENNETH,F. CONWELL
Address: Y Nb Carg (Jr Ll1g SS
Company: CONWELL & ASSOCIATES CONSULTING COMPANY
City: Cci-c, 1 Sy�YI Lp State:
Address 11771 SW 137 PLACE
Zip, Code:, �R Fax:
City:,,MIAMI State: FL _
Phone NO: aC6 SC)
Zip Code:33186 Fax:!305-385-7827
E-Mail: gN-T- f nq Q G(» Q i1 �C cwl
Phone No. 3057926-5673 ,
Fill in fee simple Title Holder on next page (if different
E-Mail: kconwell@caconsultingc.com
from the Owner.listed above)
State or County License: CGC1515386
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL-CONS1'RUCTfON LI;ENIA
,,INFORMATIQN
DESIGNER/ENGINEER:
= Not Applicable
MORTGAGE COMPANY: _
Not Applicable
Name:
Name: KENNETH F. CONWELL
Address:
Address:
City:
State:
City: MIAMI
State:
Zip: Phone
Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:.
Not Applicable
Name:
Name:
Address:11771 SW 137 PLACE
City:
7.
_.
,Address:
Gty
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,. wimming 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 lender or an attorney before
commencim work or reMrding your Notice of Commencement.
Signat re Owner/'Lessee/Contractor as Agent for Owner
Signaturelof Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY Y OF-,-,.--
COUNTY OF --DADS
The forgoing instrument was acknowledged before me
The forgoing'instrument was acknowledged before me
this 11 day of AUGUST 20— by
this 11 day of AUGUST 26 'by
(�?6 D2�'S�4rW1
WeahflA
Name:of-person -rriaking statement
IVam;kof person making statement
Personally Known xx OR Produced Identification
Personally Known is OR,Produced Identification
Type of Identification
Type of Identification
Produced
Produced
`
Notary Public- State Florida.).
(Signature oi Notary, l'�,BB�ate oCvcIgitl9)Qnwell'
(Signature o of
q' �° Commissi GG001091
Commission -No. G _4t _ �,er 2020
,"�Q.Y.?g"" Car n . Conwell
Commission No. �a4' 4 , p�V "
xpires::W 7,
'�% Notary �
= CommI # GG001091-
Bonded th' Aaron
;, . o .--.Expires: October 7, 2620
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tev. 8/2/17