HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE-INFO MUST BE COMPLETED FOR APPLICATION TO BE-ACCEPTED
Date: �� Permit Number: t3(31-(50g;
RECEIti'-D JAN 04 217
Rfi@1 ihJAp6grJiit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue,Fort Pierce FL 34982 V
_.- _-Phone: (772)4624553 Fax: (772)462-1578 Commercial Residential—
PERMIT APPLICATION
esidential_PERMITAPPLICATION FOR:��\.��o�
;. +rtd��-�D"��`.�a-.�T'-v,* 1 sA .-:e ���e,
S§E-11 INPR®UEMENT�LOCATI:t3.N: ��$ 4�
`, u".c .. r,, .r _ .1�
Address: Y I e-ro ee V
Legal Description: Smy Lyge- A-A-7-Aj UNIT M 51 l DCIS. 51, l bTS +5
Property Tax ID#: ��/ of �— �d — �� 'd b0% Lot No. s
Site Plan Name: Block No. �
Project Name:
Setbacks Front Back: Right Side: Left Side:
,�; 7Yp P .(�.., "ri,z.;�l. az I:..s std .c'W t}A3YG^'44* 'IN
� .3..� i -;+ ba"-x ad � s :#
_ DETAILE0.19 CRIPTIOWo-A RX
; �� "'�
r
r ...`_"..x :r..,..€a'' r'� .
n�
n1)0 I'alas
' , 1411 77
".:3t9
C®NSTR.IJCTtO.N INFORMTI'®N u YtAN ��
Additional wor to be pertormed under this permit-c ec a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _/,-Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ �� D®' 10 Utilities: —Sewer _Septic. Building Height:
�®U WIR-A LUESSEE �f r
�� � � CONTRAC30R ,
W.e�+
Name I el Wli LIQ F;rre5� lb Zo rrtSl LN arae: .SUn r'i`6:r : C41I
Address: 3I0 I 15Cus Ave. Company:
City: �` f\ �G� State:_EL Address: . 3 0' Pe0�1�
Zip Code: 3 Fax: / City: F=; OI P►^C'P State:
Phone No. !�%�� q`7� - �i" 772-X79-Ilb Zip Code: 4q 1 y7 Fax:
E-Mail: Phone No 22'-c220 1-- —2 c�s0
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License Ca�'C /
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIIP�LEIVIERIT' L C®NSl"RIJ.C�TION LIQ�N LAUV �N�FO�RI�/iATION
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:
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 our Notice of Commencement.
10A _qk4� __ -_ - 1 1"
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAI STATE OF FLORIDA /
COUNTY OF6t�uc l'e COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this �211�iay of 20__n by this kilA day of 20 (? by
od"
?6ne of p4rkledging) a of perso knowledging)
atureblic�Stateof Florida ) ure f Notary Public-
-at—e of Florida )
Personally Known , — OR Produced Identification Personally Known OR Produced Identification
Type of Iden 'fication Type of Identification _
Produced G�•c,�,�dtNOv/ly�__ —_Produced
-- - �ot�Ay Pt'ai.� r'K""'yILLS,SR. ',••'••"o JOHNNIE HILLS,SR.
Commission No. Commission No. * � 'II OMMISSION#FF21136
(tea I);r _ r#FF 21130 � E�PIRES:July 18,2019
wl °� !nly 18,2019 ��+,p °` Bonded Thru Budget Nota Servic
q ` Boo-adTnruBU et Nota Sarfts oFF� 9 Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
. 7/2014 7