HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALLAPPLICABLE INFO MUSTBE COMPLETED FOR APPUCATION T9 BEACCEPTED
Date: L � Di (� {
Permit Number:
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BuIldingP& ft. poicatilm
Planning and Development Services ' s
Building apd Code Regulation Division %
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23Uf}Virginia Avenue, Fort Pierce- FL 34982
Phone: (7721462-1553� Fa)i 177114621578 £DIn>Ettefcial
Residential
PERMIT APPUCATION FOR-.11 Tv Select from Oro dick arrow at the end of }irte rP rod
cam`. �" 3 fa`�'''�i i'fZ£Q .may ii 1 iX 6 'SC• off i'. �t �' $ 3+R 5
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Le at Description: Qi V t l ( ? ; lJ� K5
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Property Tax ID #: Li l 6L - `� I - DO�c1; DC� - 0 SCANNEDI_ot No.
Site Plan (starve: !
BY
Btack .No.
ele County
Project Name:
Setbacks -Front Backs Rigid Stcie'
Left
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�-GeP N S�-iel� �v+�fsb u.��P�lu�rn.•�F artd '�t�eh�,kc�l�er�.,P $h�n'�f IQ�� S�S•}tr� +.
of 12A.Se SR,, 4- a n� {-�lck �Jp�, fd .i» � f Gd 1 v+��• CR�.
HVAC _ elas Tank E]i as Pipi g
L_1El'ectric OPl'umt ing ospnnkl'ers;
Total'Sq. Ft of Construction: 3a'C
Cost of Construction: S I Lti I� �'J xifil
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1 =(strutters OWindows-/Doors
El
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El Generator _ Roof �� / �- Roof pitch
sFt. of First F1'oor:
:Sewerlj (Septic Suit&mgHeigbt:'-/
�r `` £ r�-r...�.-,„. ;c.. a,
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Name AY 1 n L-a l.J
Name: f f Ci�M SOlrl
Andress: d I � 1;ICACVA �iy�-e
Company: L . I Ll �a&Ah!e�
Address-. s'v SOu�J-- Ce ��vc� .
City: Po (+ St- Lc,� Gr C.. 3tatetgC,
Zip Code: Fax:
a
City: PC) (-- St Luua t- State:
Rhone -No. rI `7a - ci r l - Li 51
Zip code: 3 qlq 8 t4 Fax.-Ir7 10r) - 935\ 1
E-Mail:
1:
Phone No. r? a- rl lj
,.
Fill in fee simple Title Holder on next page if
E-Mail..9 ! u C e- ND O F� 'n; @ 4A'"Q o , C'Q M
from the owner fisted above]
State or County license: CC�C 13� 0�
i�
If vahre of sonstit Wan is $2500 cwmore, a RECORDED tit s# 6f Conurrensementisres uW1
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r
a-EMNf_€V€Q1 AK-1 ER,
_ too# Apphc
mmTG 1GE comPAw:
Not Apphcable
Name:
_
Name:
Address:
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Address'
LltV_
State'
�Ity.
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TnU HOLDER:
_ Not Apptica}�f : !
BONDING COMPANY._Not
Applicable
Norris:
Nam..
Address:
Address:
CkT..
City:
Zip: Phone:
Zip: Phone:
OWNERf CONTRACTOR AFF10MApplicatilsn is
I certify that no work or installation has commenced pt
St. Lucie Cou lakes no representation that is grantir
which is in with any applbotk Home -Owners A
structure. Please corisu{t witf� your Moms OwersnAssoc
In consideration of the granting ofthis requestedpermi
in accordance with the approved plans, the Florida Bulk
The following building permit applications are exempt fi
armory structines, swimming; pools, fences_ walls.,*
WARNING TO OWNER: Your faRure to Record a
imprnvgments to your property. A Notice of G
before the first inspection. if you intend to obt
commencine work or recordtnl? vour Notice of
radl=toobiain a penndiio do ttrepfTgrJc a� irtsiallati�as mist#
issuance of a permit.
ermit holder to buildthesubject structure
covenants that mgy.hvestrict-or prohibit such
Ir any restrictions wicFi rr►ay apply.
=by agreethat Ivvill, in aft respects, perforrnthework
andSt. Lucie -County -Amendments.
going a full concurrency review: room additions,
woms and accessory .uses to another.non-residentiai use
F Commencement may result to your paying twice for
emern must be remded -and posted on the jobsite
Icing, consult with lender or an attorney before
;g
Signature Owner/ LessW(Contractor as Agent for owner
Signatureof ntractor/UcenseHolder
FLORIDATE OF ' 'NO�FOR1D
I
TYOF
CNff -
-ECCO L Gr
The forgoing instrument was acknowledged before me
Tire forgoing mgm=ent was acknowledged before me
this IS," day of 0 La t- , 20-Wby
�
this t day of DC , 20_Aeby
Name of persogmak ng statement
Name of pe orynak�atement }
Personally Knowrt ), OR_ Preducedidentification
personally Known. ✓ ORProduced-kientffication,
Type of Identification
Type -of
Produced
K
Produced
(Signature of Notary Public -State of FI dda I
(Signature of Notary Public- State of Florida }
Commission No. (Seat}
Commission No_ C 0 bit!{' C E P R O U LX
o ida-Notary Public
;State
_* Commission* GG 258328
My Commission Expires
REVIEWS
FRONT
ZONING
SUP€{iVI�QN
P
VEGETATION
SEA.TURTI_E
MANGROVE
COUNTER
REVIEW
REVIEW
. (
R
REVIEW
REVIEW
REVIEW
DATI=
RECEIVED
DATE
COMP
! '
Rev.8/2/17 ,.��'�PnCONSTANCE PROULX
'�,,'sState of Florida -Notary Public
°* *E Commission # GG 258328
e:
My Commission Excites
'"r �f �ONSTANCE.PRY�U�:'
SM9 of Florida-Notsry sou
` Commission # GC 25s-*
t My Commission E •--