HomeMy WebLinkAboutMONTES 2ND SIGNATUREALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
-- J
Building Permit Application
Planning and Development Services
Building and Corte Regulation Division
2300 Virginia Avenue, Fort Pierce Fa! 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
Address: 14 [J.0 V I6,KSo)1 J(; �V
Legal Description:
Property Tax ID #: 9.5-3a— -5-00 — 00 7d, — 000 "(
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
00.4-11,11P J-6M190R,1W Phr_ rok C07037�CUCT�OAJ �i603 - X�4)
CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit — check all apply:
HVAC 11 Gas Tank E]Gas Piping Shutters
® Electric 0 Plumbing 0 Sprinklers OGenerator
Total Sq. Ft of Construction: 0 We S. Ft. of First Floor:
Cost of Construction: $ _500 Utilities:cn Sewer O Septic
OWNER/LESSEE:
Name __T09 _ mb r 11"GkOg f1an1_)6S
Address: d iu) l jj -J�
City: MIA Y-1 i L49,�5 S State: EL
Zip Code: 33016 Fax: 77�-
Phone No. 77,E 0 _ 7-5-1-F
E -Mail: -
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
Windows/Doors
Roof
Building Height:
CONTRACTOR:
Name: el-NUx (�E�, ""�•� ,► 1i
Company: ACCc1P1q-_rF� E46 -CM -1 I 0AJ7K- ACir-61'A1C
Address: 73M CL)I1671 PL
City: I1cJ 3— g�r- Lt;C 1C_ State: FL
Zip Code: 3 4 95_cz Fax: 7P— * 9'—L4—>q
Phone No. *77,- 370 — 5 -7515-
E -Mail: bCV'9/ iNC14 C& AV_r IU''C-I'-
State or County License: __ __ _ _ 0000 :30W
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN 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 BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Rhone:
Zip: Phone:
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, perforin 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 i spection. If you intend to obtain financing, consult with lender or an attorney before
commencing wdrk or re ding your Notice of Commencement..
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Signature ocaner/ A nt/ Lessee Signature of Co Tactor/License Holder
STATE OF FLORIDA f. STATE OF FLORIDA „%���
COUNTY OF ti -' r r _ COUNTY OF //�1��lJ' /Gcc"��
The fq5fping instru ent was agknowledged before me
this-22dayof X714 -,L 20 Eby
1�
(Name of person acknowledging )
� le -
(Signature of Notary Public- St -6e of Florida )
Personally KnownOR Produced Id'g1�X1q
Type of ldentification Produced 4q\X'69�BE C. W
Commission No. ��ti,S�%9 ' is ber2y�¢�6
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Revised 07/15/2014
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REVIEWS FRONT ZONING VISOR
COUNTER REVIEW REVIEW
DATE
COMPLETE
INITIALS
The fo oing instrument was cJ�owledged ore me
this lay of 'i1•j 20 py
(Name of person acknoQed in
g)
(Signature of Notary Public tate of Florida }
Personally Known OR Produced Ident'Potliilk 11tH
Type of Identification Pro uced ? `
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Commission No. lF6 qXj `(S etobef22 tc
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REVIEW REVIEW REVIEW REVIEW