HomeMy WebLinkAboutBuilding Permit Application ALLAPPLI CABLE I NFO MUST BE COM PIAT D FORAPPLI GAT ON TO BEACCEPTED _
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Cbde Fbgulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commerdal Fesidential x
PERMITAPPUCATON FOR To Select from dropbox, click arrow at the end of line
PROP�O�SED I M PMVB\A ENT LOCATION
Address: S 6`1 0'�Il W1ek6 2t/i 1>t l V C-7-- f 70-rli(— P+ey E.( FL
Legal Description: I K-P )V4 f2 VrDvE_ ESI, TE1 S "UN I LDC(C&Cq
lT Z l VVVW I(Sx'6s2 -I Lfz
Property Tax I D#: 340z- --G oq OCP Z-7-0 00-3 Lot No. Z-I
Ste Plan Name: Block No. O9
—
Project Name:
Setbacks Front Back: Rght Sde: Left Elide:
DS DE9C�I F.M O
ETAI LF WOFK
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I"6bN.sr,,R!jcn,.oN',I,NFORM!A!10N ,....
i ions wor o e e orm under is perm - a appy:
❑HVAC Gas Tank ]is
_Stutters ❑WndowsJDoors
❑Bectric Plumbing ❑Sodnklers ❑Generator ❑ Fbof
Total ga. Ft of Construction: Ft.of First Floor:
Cost of Construction:$ �Q.' Utilities Sewer 0 Septic Building Height:
QWNB?l L ODNTRAGTOR
Name DEN II_IGE CONNGfz-S Name: A t-T S-roybe_
Address: Q12 N. L(O- k Me0J LeT- Company: r4P.r STove.2 PLUM91 t-�C
Qty: 1NOQ1!':, gate: Address: SLAZ ley W P Da4� NT1 LC EtA C:t
Zip Code: -Z-I Fax: NIA Qty: L.VCt C gate:
Phone No.95 —11 Zp Code: 3�(�`i�(� Fax: "17Z-8�g-Z7f7
E-Mail: Nle Phone No.
FII in fee simple Title Holder on next page(if different E-Mail: STt�gIZPW�3i (�C VtI�-
from the Owner listed above) gate or ODunty License: t-]q<6_9
If value of construction is$2500 or more,a FEOORDm Notice of Commencement is required.
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JPPL /IBNTALQONSTRUCIION LJBV IAW INFORMATION
DE9GNERENCNEER _Not Applicable M ORTGAGE OOM PANYNo,t
Applicable
Name: Name:
Address: Address:
Qty: Rate: Qty: State:
Zip: Phone: Zp: Phone:
FEE 9 M PLE TI TLE HOLDER Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
Qty: City:
Zp: Fhone: Zp: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
3.Lucie Count makes no representation that is granting apermit 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 a.Lude County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
awry 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 ' your paying twice for
improvementsto your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first ini oegtiQ If you Intend to obtain financing, consult with le r an attorney before
commencing workXre&dft Vour Notice of Commencement.
s
_9gnature of ner/ Lessee/Agent 9gnature of Contract /License Holder
oAT OFOF ORI DA �T STATE OF FLORI DA
OOUNTYOF tT7 wG t=
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this r day of_V N C 20 r!5iby this_Lday of J VNO 20 tSby
l 60ti EUE- selev1anirCti�f->—U.E S1&Lwol'i
(Name of person acknowledging) (Name of person acknowledging)
__ �4-4�-w,- .I Qwu�-Z
(9gnature f Notary Public-EIRM Florida) (9gnatu a of Notary Public-S e of Florida)
Personally KnownORProduced Identification Personally Known X OR Produced Identification
Type of Identification Produced qW P Type of Identification Produced
z��;•••.�% MIUMELE D.SIGIVIONrr� �°;••••,��o MICHELLE D.SIGMON
CoPIRES:mmission No.�dfv��b 0� MMISSION#FF 063801 Commission No:t?o 31 0,%MMISSION#FF 063801
EXOctober 16,2017 NgrEXP((RES:October 16 2017
w'"rFOFF���Oc
Bonded Thru Budget NoWy Unites ' FOF1°a�O� BondedThruBudpetNotaryServices
Revised 07/15/2014
REVIEWS FRONT ZONING 9JPERVISOR PLANS VEGEFATION gATURT_E MANGROVE
COUNTER REVIEW REVIEW REVIBN REV EW FEVIBN REVIEW
DATE
ODM R=
INITIALS
X WATER Comm
ST.LUCIE COUNTY UTILITIES-P.O.BOX 728,FT.-PIERCE,FL 34982
SEWER RES
METER SZ. M/F
ACCT. 39yq
IRR. -C� EY
SECURITY DEP O'
SERVICE FEE
SAME DAY FEE
-SUBDIVISION
OVERTIME FEE
METER INSTALL.
CFC/WATER
FPUA CFC ( qS-9�5' MOVE IN/CLOSING DATE
CFC/SEWER
GUAR.REV. This application hereby request and authorizes the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,
LATERAL rules and regulations,which by reference are made a part of this contract.Applicant agrees to pay
the Utility promptly for such services in accordance with the established rules and regulations.
3710 0 0 TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER?
)
SOCIAL
SEC/ —/
9NATREA FED ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED elc9q10 CASH CHK# &)Ii� RECEIVED BY/aOa,/Ld