HomeMy WebLinkAboutRoccon App 2kil APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
W.
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
PERMITTYPL —�
Address:
Property Tax ID #:
Site Plan Name:
Project Name: —
CCINSTRUC70 N !NFORMATIOf
Additional work to be performed under this permit— check all that apply:
Mechanical Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft Of (_.0riSrru:tion:—
r�U
Cost of Construction: $ _
Lot No.
Block No. _
windows/Doors
Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Name P. WnctnA.,
Address:�(Q Qiyef- W2014 Un
Cite:' _.IP(1t/ State:
Zip Code: 34-�(d Fax:
Phone No.-1A
E-fvlaii.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: , 311alL 111
Company: MIA 94TWp(,SG of P'XeW4 W RBt W, &(ML
Address: /10 13 TOfhah•AM)- D(' Der'
City: ibilw..: &rbLK &_ack. Stater
Zip Code: 3a93l Fax:
Phone No i`7 d- 337- 4j{'%0
E-Mail JgLa s 0
State or County License a q''L11
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is p7,500 or more, a RECORDED Notice of Commencement is required.
101, 1 8- ON
DESIGNER/ENGINEER: _Not Applicable MORTGAGE.COMPANY: _ Not Applicable
Name, Name:
Address: Address: _
City: State: City: State: _
Zip: _—_.._.. _• -- Phone ___.---- Zip: -- — Phone:
FEF SIMPLE TITLE: HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: _
Address-
City:
City:
Zip: _ Phone:
Zip: Phone:
WNER/ CONTRACTOR. AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work of installation has commenced prior to the issuance of a permit.
t. writ I:oCluty ir,ak .; no representation that is granting a permit vvii! auiFiorize the permit holder to build the subject structure
aws or and nts hat restrict or such
which may appjyhlbit
trluclt. renPleaslaccrn withrestrictions
with your Hle Home ome Owners Assocwners iation and your deed for any
n consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
n accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
i
he following building permit applications are exempt from undergoing a full concurrency review: room additions,
rooms and accessory uses to another non-residential use
cc�s,ors, Structures, sw inning pools, fences, walls, signs, screen
WARNING TO OWNER. YOUR (FAILURE TO RECORD A NOTICE OIL COMMENCEMENT MAY RESULT IN YOUR PAYING
RWhYE (FAT± khi�ROME'MENTS TO YOUR PROPERTY. A MOThf.E OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON TBE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIYH YOUR LENDER OR AN AIFFORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
i
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contra for/License Ho er
SLATE )IF FLO
STATE OF FLOR�}�4A
CQ17��ITY y�-- --- —
COUN FY OFAl �l� _.
The fori,oing ir,sti iiierit. was aLImiowieciged uefore me
l ate forgoing msti ufnenc was acknowledged before me
L Q day of J Z by
this day of1=��20,3jE) by
this
i
Name of person making statement.
p g
Name of person making statement.
Personal,v Knowr, ._ _..� OR Produced Identification
Personaliy Known )ic OR Produced Identification
I
Type oil ident,fi, at.c:-,
'iype of identification
i
i
Produr?d........
i Produce d,. __..
( ignature of : taryP !blic- State of lorida)
ignature of N ry Public- State of Florida )
Cornrnissic, o G�C� �+" eai)Notary Pubic State of
1&gWm' :ion No.a�ff, ��7e (Seal)
I
Ashley M Antonelli
y Commission GG 1
29_70
REVIEWS FRONT
xpires iu/1810,21
ATION
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Notary P
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lic State of Florida
ist�gg
COUNTER REVIEW
REVIEW
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DATE
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COMPLETED 1- -- — --- --
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