HomeMy WebLinkAboutBuilding Permit Application Feb 22 16 12: 19p Treasure Coast A/C 7723359121
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PLANNING.AND DEVELOPMENT SERVICES DEPARTMENT
i f BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: �' _G; 'L( ADDRESS: t w1 �t tZ C�G r �.1 L
I= l itjl{ -� ��`'� ,am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TIlVIE RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification �(:i1;i. f i}v`fl r. ( +y—e� i; .1- r� �;-�r=� �tJ tiff r 1", 4-
OWNE DR OR CONTRACTOR SIGNATURE DATE
R
;r a -
Print Name
STATE OF FLORI
COUNTY OFu
ACKNOWLEDGED BEFORE ME THIS 7k/DAY OF t'�i�i tl'�. 20 1 ?
BY �L LL'C'f f�L 'L WHO IS PERSONALLY KNOWN TO ME ti .OR
HAS PROVIDED AS IDENTIFICATION.
STATE OF FLORIDA,County of
JOY D ADAMS
*� Commission#EF 907740
SIGNATURE F NOTARY 3fiA -, vp*�: My Commission Expires
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Jul 16 15 08: 00a Treasure Coast A?C 7723359121 p. 2
ALL APPLICABLE INFO MUST BE COMPLETED'0 PPLICATION TO BE ACCEPTED C�
Date: /l i �J /�`(Q ! Permit Number: /—D 02
&VEN,
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: Y'%,4 U 6, d Pio2-�- . 0 i (lt_ U:>i � !„ i- bi LCz C, 3 (05-2,
Legal Description: (_,CJ.VV- �Ll�.l� ���C� `.a }I CL Ir (�(i�. �1'�=r LI + i U,( J� 47'
Property Tax ID#: ,z(D /03a —000 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
J ) �. .l l4'/y �� l/� �l✓
L
CONSTRUCTION INFORMATION:
Add Itina work to be ertormea under tispermit—check all appy:
[YHVAC Gas Tank ❑Gas Piping _Shutters a Windows/Doors
01 Electric Plumbing Sprinklers E]Generator Roof
Total Sq. Ft of Construction: Sci.Ft.of First Floor:
Cost of Construction:$ C C r Utilities:7 Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
'Name I114- i1CA Name:
Address: `',' a>> (i'yt, 41'c Company:
City: ? -;jiT — State: ' � Address: VCS
Zip Code: Fax: City:✓t rt1S`�+u - C�r� f State:
Phone No. -7 1'/-- 5�Dq'• 5° Q Zip Code: y5 Fax: ?7Z 3 `�cTll
E-Mail: Phone No. 77Z-6—! /16/
Fill in fee simple Title Holder on next page(if different E-Mail: Z,'tC� lc/"/t, (::*1 T,M7
from the Owner listed above) State or County License: C'a - C 5(0 `/7�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Jul 16 15 08: 01a Treasure Coast A/C 7723358121 P. 3
SUPPLEMENTAL CONSTRUCTION LIENIAW 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 BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
1 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 OwnersAssociation 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 our Notice of Commencement.
Y _ , s
_Signaturre f Owner/Lessee/Agent SignhtqEq_9VContractor1License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF -->7-- U-'r�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this / day of 20 0.13y this 6 day of 20 t-5 by
(Name of person acknowledging) (Name o erson acknowledging)
re of N tary Public-State of Florida) (Sigaatdre ofVaary Public-State of Florida)
Personally Known OR Produced Identification Personally Known Y/" OR Produced Identification
YP
Type of Identification
Type of identification Produced
JOY D ABBOTT p� TT
° "� J OY D �
-• °- Comm� � q EE 865065 GOmmission No. .
Commission No. _. .E —r commission 65065
My Commission Expires �- --
'`'��a;,;,��° January 14, 2017 :� My Commission Expires
2.n,uac
jonucify
Revised 07/15/2014
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