HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE C611VIOLETtD.FORAPPLICATION ,T0 139-ACCEPTED 1.
Date: Permit Number:
CEIVED
in''g .. Perm it.Applica
Planning and Development Services 71017
:
Building' andCode Regulation DivisionGCT
2300 Virginia Avenue, Fort Pierce FL-34982 - ent,
Phone: (772) 462-1553- Fax: (77-2) 462-1578 Commercial I I LpMppli Wtiln g Cpart'
Rt.- LuFL
PERMIT APPLICATION FOR: "To Select from-dr 'pbox, Click arrow at the end of line.
PROPOSED !MPRCVEMtN
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dress: L-TIM)$a' CC,, - - - :,
11-�'-y
Legal Description:'
Property Tax ID #: O.PG 7 Lot No:
Site Plan Name: I Block No.
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Project Name:
Setbacks Front- Back: Right Sii1o'-' 'Left Side:'.
ION OR LEDO SCRIPT
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ONST•RUCTION1N FORMATION'.,
,'ACIClitionaiworEtoba�nertormed unddir
this permit- check all
ttLat app
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HVAC
13
Gas Tank.
Gas .Piping
—
Shutters
r
Windows/Doors
FlElectric
0
Plumbing'-'
Sprinklers''
E]Generator
[:],Roof'
Roof pitch
Total Sq. Ft of Construction: S Ft of First Floor:
I . - Sewer'El -H6 ght:'
11 1 'In — " -, -I n Cost of Construction: Utilities Sew6fEl Septic -'BjUdi Building,Height::
DOWNER/LESSEE `.4
CONTRACTOR :.,,"'
)Name 4E
Name: KENNETH F. CONWELL
Address: i L I 0- -, c
Company: CONWELL & ASSOCIATES CONSULTING COMPANY
City: ccx-c, � S . State:.f:L-
Address: 11771 SW 137 PLACE
Zip Code: Fax:
City: MIAMI State: FL
Phone No. C-)
Zip Code: 33186 Fax: 305-385-7827
E-Mail: (n f c r-yn
Phone No. 3 05-926-5673
F in.fe'
Fill Title Holder on next.
� simple T page
'Kd I dNWELL(a)6X6.0NSULTINGQ-C:6M
E-Mail 7.
from the Owner listed 'above)
State or County License: CGC1 515386
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
$1
SUPPLEMENTAL CONSTRUCTIION IIEN,-AAW INFOR'MATIONr.',
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DESIGNER/ENGINEER:.. . _
Name:
Not'Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Phone:
Address t �� I
ti
tit" +� r, j " a� , }'
Zip• �,, a°'Phone:-• '' � �
I
State:
SEE SIMPLEiTI:T11,1-HOLDER: _
Name:
City:
Zip: Phone: " _'
Not Applicable
BONDING COMPANY:. Not Applicable
Name:
_Address•
City:..
Y
Zip: Phone: -
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 Horne -Owners Association rules; bVlaws 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, t e Florida Building Codes -and St. Lucie County -Amendments.. _ - The following building permit application are exempt from undergoing.a full concurrency review: room additions, '
accessory structures, swimming pools, fer ces, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failur 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 t first in sp n. If you intend to, obtain financing, consult with lender or an attorney before
comm In wor rec rdin your Notice of -Commencement:
S -
Sign t re of Owner/Lessee Contractor as gent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA 1 n STATE OF FLORI A /1
COUNTY OF d/-✓✓l / �/� �,r i COUNTY OF �j:
The f going inst ument was c owledg�d before me The for oing instru ent wa acknowledged.before me
this day. of �-< 20by_ this day of 20 by_ }
(Name of person acknowledging) (Name of person acknowledgingAi
(Signature. f Not ary.PubliR- State of to id' (Signature f Notary Public- State of -Florida )
I;aroiypv. conwell
Personally Known rtc 9�8InifAM091 Personally Known OR Produced Id e Aifcationy
Type of Identificatioa4r = Exnires:lOctober T 20 � Type of Identification -Produced -
'- eo'n'ded
hru Aaron Notary .11 %� aro yn- onw►ell
Commission No. ��� ( eal). Commission No. ommissiol(SdaI0G001091
_ 4 -Expires: October T 2020
Revised-07/15/2014
REVIEWS
FRONT,.-,-.-
SUPERVISOR,
PLANS
VEGETATION- "
SEA TURTLE
MANGROVE.
COUNTER -
„ZONING..
'.REVIEW
_
_REVIEW` '
REVIEW `
` REVIEW' -
"REVIEW '
REVIEW '
DATE
_ • .
COMPLETE
INITIALS
_
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