HomeMy WebLinkAboutGladchum Larry ac changeout permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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
t%EMENT LOCATION: _T
Address: i "
Legal Description: kiy ex� de.
Pro ertTax ID #: L1q0b—'51v-00'z-&—D00zq
Lot No.
Site Plan Name:_(L(.t-/? Block No.
Project Name:i'ial7��A
Setbacks Front Back: Right Side: Left Side:
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iti a wor to e e orme undert is permit —check a apply:
HVAC Gas Tank I]Gas Piping _ Shutters ❑ Windows/Doors
Electric 0 Plumbing Sprinklers Generator FIRoof
Total Sq. Ft of Construction: S . Ft. of First Floor:
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Cost of Construction: $ �(1�'�(p Utilities: _ Sewer Septic Building Height:
CONTRACTOR
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Name lice 11 Name: ,e
Address: Compan V
City: 4IOOrYI-Pr neo iit lig Stater Address: 1 6-1 r �r1�7j�W
Zip Code: D%Fax:�7Z �9� � Z% City: �f�/��7f-.LCu _ _ tatte FPhone No."%2Z-3y� ZipCode`��-i"'�2 Fax7�Z�-/7�E-Mail: CGX6 •/% Phone No. 77Z `q 12Fill in fee "' ple Title Holder on next page ( if different E -Mail: wcar 1 on aCt G�n'1
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from the Owner listed above) State or County License: J
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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 thepermit 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 record rm your Notice of Commencement. //
Agent
STAT"F"RLORIDA
COUNTY OF S LU r_ t e—
The forgoing instrument was acknowledged before me
this ZL)"day of 20 Eby
-r
ctor
ST4TCIOF FLORIDA
COUNTY OF �g} L.0 c I e
The forgoing instrument was acknowledged before me
this-7��r day ofFi�20 1�P,by
e ff re ` j G r0 5YY1Cr -Yt n ff-r^e t,j C vv S srvta r� r,
(Name of person ac nowledging ) (Name of person acknowledging )
(Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
✓
/
ZONING
Personally Known
OR Produced
Identification
a�^ ,71 v im. l r ar MOW;
Identification
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
— Not Applicable
Name:
REVIEW
REVIEW
Name:
Address:
Commission No. FFOC`1 da
;�;Gs,
Address:
City:
COMPLETE
State:
City:
State:
Zip:
Phone:
Zip: Phone:
INITIALS
FEE SIMPLE
TITLE HOLDER: _
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
My CUMMI Z>IUN 91' 009222,
EXPIRES August 7. 2017
Name:
EXPIRES August 7, 2
Address:
(407) 398-0153
Address:
City:
FloridallotaryService.c
City:
Zip:
Phone:
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 thepermit 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 record rm your Notice of Commencement. //
Agent
STAT"F"RLORIDA
COUNTY OF S LU r_ t e—
The forgoing instrument was acknowledged before me
this ZL)"day of 20 Eby
-r
ctor
ST4TCIOF FLORIDA
COUNTY OF �g} L.0 c I e
The forgoing instrument was acknowledged before me
this-7��r day ofFi�20 1�P,by
e ff re ` j G r0 5YY1Cr -Yt n ff-r^e t,j C vv S srvta r� r,
(Name of person ac nowledging ) (Name of person acknowledging )
(Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
✓
/
ZONING
Personally Known
OR Produced
Identification
Personally Known OR Produced
Identification
COUNTER
Type of Identification Produced
REVIEW
Type of Identification Produced
REVIEW
REVIEW
REVIEW
Commission No. FFD09
Commission No. FFOC`1 da
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ea
COMPLETE
KRISTINA L LOUDERB
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K ISTINALLOUDERIIA
s
INITIALS
My COMMISSION
Revised 07/15/2014
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My CUMMI Z>IUN 91' 009222,
EXPIRES August 7. 2017
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398-0153
EXPIRES August 7, 2
7
(407) 398-0153
Floridallotaryservice.com
(407)
FloridallotaryService.c
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MANGROVE
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