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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST-BE COMPLETED FOR APPLICATION TO BE ACCEPTED A-11 _ Date: d - Permit Number: Building Permit Appli ation FEB 2 12020 Planning and Development Services Building and Code Regulation Division 9 2300 Virginia Avenue,Fort Pierce FL 34982 � Phone: (772)462-1553 Fax: (772)462-1578 Commercial R-esidential­­ PERMITTYPE: t)6m06--/ r/O6J PRO SR@Ppp1,M' OUEM9NT LO AT1,( Address: - Property Tax ID#: b-5 K (2 Lot No. Site Plan Name: Block No. Project Name: DE 1LE�D DE-�SCR�lPT1ON O>=WORK: b-et-1 z-, -uco/ ©r- co 196�T/6os TaT-l2v�Tc�Z4-r- M,NL STRUCTION 1NFORIM! ION: 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. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ Utilities: —Sewer _Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name GkSiLC A^es �L'41%-ew e? Name: 141L110 !:5'pU7-U Address: -31AoL.l- ^ -rp-G� IrA41 L Company: 2GrSF7-oe City: ©6T 5T L UCI C- State: Address: 10g ESGAyo�►A- /� Zip Code: Fax: City: State: /2 Phone No. -79 X601 Zip Code: Fax: E-Mail: Phone No -7 ZO" Z9�0 3 ¢q� Fill in fee simple Title Holder on next page(if different E-Mail 10671V45z-A14P/4/sex-Is 4,u'4ic ' 4"o'1 from the Owner listed above) State or County License G-46 1 ZS9 ZD$ 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. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIQN. DESIGNE ENGINEER: _Not Applicable MORTGAGE COMPANYi _Not Applicable Name. _ Name:i . Address: Gty State.: City: State: Zip = Phone: _ Zip= Phone.•; FEESIMPLE TITLE HOLDER: Not . Name• Applicable BONDING COMPANY. _Nat Applicable: Name:. .,,Address.- Address: aty _ - City: rPPhone::, Zip Phone- OWNER/CONTRACTOR AFFIDVIT Application`is hereby.madeto:obtain a'permit_to do the work and iristeUation as indicated. 1`.oerttfy _tNA orinstaliation has commenced prior to the issuance of a permit. 5t.Lude"Coun makes no representation that is granting a emit wiltauthorize the permd holder to build the subject structure:" which isan conflict with any applicable Home Owners tion rules,-bylaws or'and.covenants that may restrict orprohibR such. strucuun?.Please,consult with your Home Owners Assodatmn and review,your deed for any ri-Arkdons.which may"apply..- 1 in consideration of the granting of this requested permit,_I do,heieby agree that)will,in all respects,.perform thewwork in accordance with the approved,plans,ahe Ronda Building Codes andSt:Luae County Amendments:- T .0 following building permit applications are'exempt from undergoing a-full concurrency reyiewc room additions, accessory structures,swimming pools;fences,walls,.swris,screen rooms and accessoryuses to anothernon-residential use 'ITARNIiiG TO`O)1►NER: YOUR FALtJRE:TO RECORD.A RD=, OF`ttAMMEIYCEMENT [MAY'i SILT tN YOiSt PAYMG T1y10E,FOR:1 R0T►EIIIE111T5'TO YOUR PROPERTT. A NOTICE:OF.COMMirNCE1Mtl1(T,MUST BE REGORGED AND ON TiIE:JOB. . BEFORE"THE FIRST NSPEC110N. IF YOU>NTEND TO`;OBTAiN FRIiANCiIVKy:;COMSULT ATTORNEY BEFORE OF MENCEMENT°.' Signature of Owner/;Lessee/Contractor as:Agent fbVOWner Signature of Contractor/License Holder ATE-OF-ft I Olar�t o. STATEOFft9RfBA- a . COUNTY COUNTY OE 0 The oing in It t was acknowledged before me The forggmg instnim t was a& ledged before me, thisl,L ay of if- 2oGQ by this a of rtir 20 ep.6y Y_... A r ` : Name of person making statement. Name of person making statement. Personally known Personally Known Type of identification. MARK ANDREW B N Type of identification. ;MARK MOREW BONNEMA Produced NOTARY PUBLIC Produced = NOTAR :RIBUC LORADO: `0 COLORi4D0 NQTAAY"1020184039034 NOTARY 10 M184039034 NiY CQMMISSION DIPIRES.00TOBER 3 3022 MiY C0AiM15SI0NS:t)CT08FR 9,2022 (Signature:of:Notary Public State of;FlOdda) (Signature of Notary Pubkm State:ofFlorida I :Commission No9Ol�W3-10 (Seal) Commission.No .0'-04 (Seal) REVIEWS: FRONT _ :y ZONING< SUPERVISOR PLANS VEGETATION SEA'TURTLE MANGROVE _COUNTER' REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW: DATE RECEIVED DATE COMPLETED ::` ; ev: