HomeMy WebLinkAboutapplication (2).pdfAll APPLICABLE INFO MUST BE COMP. ED FOP t DPLICATION TO BE ACCEPTE
Date: 0 I T Permit Number:
SCANlur.
BY-
Builc WRt Applicatio
Planning and Development Services L79-0j//3
Building and Code Regulation Division •+� 'X5'd/d
2300 Virginia Avenue, Fort Pierce FL 34982 2 y�
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial l Residential %\
PERMIT APPLICATION FOR: w (' k)Perg4.1✓
POSED IN TION:
Address:
Legal Description. •2ilJ�
Property Tax ID#: �` , Lot No. 5240—
Site Plan Name: S.1/ t4W6-1�,C/ x �i+J� Block No.
Project Name:
Setbacks Front Back: Right Side: 60 0 Left Side: • 2
-
RIPTION OF WORK:
Q ' g-.
x/,Z- //
2
CONSTRUCTION INFORMATION:
Additional wor to oe pertormeo under this permit - cneCK all tat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator VRoof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
0
Cost of Construction: $ Z4000_ Utilities: -Sewer _Septic Building Height:
Nalce Na e:
Adiress: Co pang:
t1�
Ci State:( Ad ess:
zip Code: �nFax: Cit State
Phone No. � I m- DSq Zip Code: Z- Fax:
E-Mail: Phone No. "
Fill in fee simple Title Holder on next page ( if different E-Mail:
from the Owner listed above) State or County Licbhse:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
IQ .,
PPLEMENTAL jION LIEN
SIGNECR/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
me: JEHy� 6VA, SC/L✓ 1C�
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Name:
dresses .G
Address:
City: State:
y:Aja Az State: �!
: 3385 3 Phone: f63 -JT7 - 5%9-0
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 CounfV mikes no representation that is granting a perrr�t will authorize the permit holder to build the subjectstructure
is in
which can with any applicable Home Owners Association rules, bylaws or and covenants that may restrict ofprohibit such
structure. Please consult with your Home Owners As ciation and review your deed for any restrictions which may apply.
In consideration of the granting of this requeste ermi I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the F ida Bu ng Codes and St. Lucie County Amendments.
The following building permit applicati e pt from undergoing a full concurrency review: room additions,
accessory structures, swimming po alls, signs, screen rooms and accessory uses to another non-residential
WARNING TO OWNER: You o Record a Notice of Commencement may result in your payi
improvements to your pro . A Notice of Commencement must be recorded and poste site
before the first inspe . If you intend to obtain financing, consult with I er or an a ore
commencing workRf recording Ayr Notice of Comity cement.
Signature/of Contractor/STATE
S' ure of wn___er�r/�/111Ag�I�ent/ Lessee
STATE O F . &6571 '6'
COUNTY OF ��(� //.f��[[
OF �Lice�nse/H�oolldeerr
COUNTY OF �rTL /C.aU��
The f r in w owled e�}fore me
The fyrQoin instru t wa acknowledged Wore me
this day o 2Q/"/ by
this day of Z7 20�y
,
7A14eQ1\it%IA,
1LJ/Q1CC�
(Name of pers acknowledging
(Name of per wl dging )
of Notary Public- State Florida)
ronally
ature of Notary Public- State of Florida )
eKnown OR Produced Identification
Personally Known
Type of Identification Produced ��
Type of Identification o�lyd,!". TAMANTHA WOODS
ri° ,`�% Notary Public - State of Florida
Commission No. A,uf'A WOODS
• •
Commission No. �/� y �Com jgq�res Aug 2. 2017
. s Notary Pu - State of Florida
.
i Commission * FF 038406
•si My Comm. Expires Aug 2, 2017_
»t�"•• Braided Dwogh National Notary Assn.
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DATE
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DATE
COMPLETED
L
ev. 7/2014