HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr A
ALL APPLICABLE INFO MUST BE COMPLI-'-
Date:
FOR APPLICATION TO BE ACCEPTED
bUlANNILU
BY
St. Lucie Cnuntt
Permit Number:
Building 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
RECEIVED
APR 2 5 2018
ST, Lucie County, Permitting
Residential &
PERMIT APPLICATION FOR: Window/door III
I PROPOSED IMPROVEMENT LOCATION: III
Address: 4100 N A1A Bldg. I Unit 121
Legal Description: TREASURE COVE DUNES UNIT 121 (OR 1088-1333)
Property Tax ID #: 1423-502-0004-000-1
Site Plan Name:
Project Name:
Setbacks Fr
Back:A) In Right Side: A) /A Left Side:
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: III
DOVyyAND DOOR REPLACEM T TOMS o¢ VI/m Wd6w 5 "n
V5/r dj,15 ale, e,5 OOD.5 in U of_e n'rj5 3 o51r)S /m psa piny / Fmm,e
Enee g b_fFjc_:,e.� Cw5 W)ndowS a boars
CONSTRUCTION INFORMATION:
na wor to e e orme under t—checkispermit a apply:
11HVAC LJGasTank ❑Gas Piping In Shutters Windows/Doors
11 Electric 0 _
Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ / % liM.C70 Utilities. Ft
0 Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name F ^ r^✓ `•r 9Y"' r%<renLp
Name: Cil zzV'7r _scE
Address:4100 N A1A BLDG I UNIT 121'— D< < g6s..3i'/7ID.
Company: TELESS &l/LD S
LLG
City: 5ft&'.5' State: FL
Zip Coder 0316 (a Fax:
Phone No.305-433-1870
Address: 09690-'!2EW,077iR/i2_
/_/r7VE
City: Rez__a LELc
Zip Code:Fax:
Phone No. 12LZ) 01%/ 3
State: %Z-
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: 6+21RC-?V669664450497J-,
At03r
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
4 . .
SUPPLEMENTAL CONSTRUCTIO'rv-zrIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Address:
City:_
Zip:
_Not Applicable
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 lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signature ofOwner/ Lessee/Contractor as Agent for Owner
Signature of ntractor/License Holder
STATE OF FLO DA
STATE OF FLORID
COUNTY OFF. GIJGi�P
COUNTY OF " Lve�-�
The fprg ' instru s cknowledged b fore me
The for ���1g instrumen was acknowledged before me
`L-day
thj day of�� 20�y
thisoi of / 20_15eby
ifa y%V T 7-P s-e
Tel-e o -Q
Nan,fe of personaking statement
Name dt personl»aking statement
�y
Personally Known i/ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
¢—
(Signature f Notary Public -State of Florida I
(Signatur of Jotary Public -State of Florida
Commissio % ;: MARY ANN MA�' ITI
'' MARY ANN MA TI
Commission '�P" '`ki.= S��I
ION 1< FF953138
953
SION 11 F 953138
EXPIRES
EXPIRES January 24. 2020�??+'
January 24. 2020
IOU/18'R; U'•.3 F
40/1 dIq,0,g Fk,mNNnmv9i•ry
REVIEWS
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ZONING
SUPERVISOR
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MANGROVE
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REVIEW
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DATE
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DATE
COMPLETED
Rev.8/2/17