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HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT TYPE: Address: Building Permit Application Commercial Residential ►/ Property Tax ID #: All*,? ( Lot No. l//I Site Plan Name: lAim Pbr�tiA Block No. _ Project "Jame: _ � , -• . tie, , a��. -. Additional work to be performed under this permit — check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters ✓ Windows/Doors _ Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. F` of Constru-tlon: Sq. Ft. of First Floor: Cost of Construction: S� Utilities: _ Sewer _ Septic Building Height: Name ` �� Name: Address: i D ` Company: Mkk EA*msG of T'reya& MA Rgr• Siov City: -i! _ _tState: M Address: /to 13 T01'hikAOk- D(- Dom' Zip Code' _ _1 Fax: City: �11d m\_ i- 00ALr PsQUGG� State: Phone No.-30q-(P-7 5(03 Zip Code: 3a9bl Fax: 3A(-?1-]- 4;34- _ E-I'✓laii. Phone No i%a-337- 4VO Fill in fee simple Title Holder on next page ( if different E-Mail SLUM 0�YeUSfO�r�et�( r1�.-i' from the Owner listed above) State or County License�g3f 7 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. ^Applicable DESIGNER/ENGINEER: _ Not 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. Lucit? :;o4i itv make; n,) representation that Is granting a permit vviil 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, acc s-zory 9trucl.�IrE ;, sw inming 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 TW1^:E FOR LN-PROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT W'dA'H VOLR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Scary) C INYL1)/ Signature of Owner/ L ..ssee/Contractor as Agent for Owner Signature of Contractor/License Holder li STATE :ZF FL©r.iG' ,, ��J COUNTY �1(- -_ ��_�L__- —_ — � STATi. OF FLORI COUN FY OF ��-PAG�t�ILy' _. The forgoing instrt ir,Eril was accnaw,eoged uefure me this 1� day of Q_ 204V by Ii,c forgoing instr en was acknowledged before me this I -day of 20a by t ' NN"ame of person making statement. Name of person making statement. Personal,y Knowr, ._ OR Produced Identification Fersonaliy Known _ OR Produced Identification Type of icfent-ficatio- PredutIiad........._ . --...-_...... i ype or identification I Produced_ (Signature of tart' Public- State of Florida) (Signature of No Public --State o orida ) Commission No. h� ;,$ 1�+�/��I�N` mission No. .Ga �d� Notary Public State of Florida' f1l Antonelli .►*` Notary Public State of Fl :° FAshley M A t an REVIEWS FRONT My Co expire mission GG 75297 J,0,?M'ISOR ANS 4IEW VEGETATION y;-_ � SE TO y Commission GG 15 Rlrll'A�' t� 9 COUNTER REVIEW DATE RECEIVED DATE -_.�— - ---- — CGMPL.ETED - - - --- - ev. Z/ 7/ 1.9 =1 W