HomeMy WebLinkAboutBuilding PermitII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Illkkk!!k 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 X
PERMIT TYPE:
Property Tax ID #: Lot No.
Site Plan Name: _ . m Block No.
Project "Jame:
Additional work to be performed under this permit- check all that apply:
Mechanical Gas Tank
Electric _ Plumbing
Total Sq. r-t o` Cnns�ru;:tion: ____
Cost of Construction: (D�J.f�IZ
Name
Address:
Gas Piping
Sprinklers
— Shutters
_ Generator
Sq. Ft. of First Floor: _
Utilities: —Sewer — Septic
City: U State:,
Zip Code: $ Fax:
Phone No. nr1l -tea- 3$S- 2�
E-Mail.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Windows/Doors
Roof Pitch
Building Height:
Company: M►A &TIErxis(, of P'XeUurdL f�A ect5{cM+� l
Address: /to 13 'rOP1'►ah.44Aik- D(-
City: A(anlAlrbs Y PJea(, . State: FL
Zip Code: 3a931 Fax: 3ai. 7-n-4a3
Phone No -7% a- 337- 41f-10
E-MailV1.u.m 0�IreaSfonrlerxr�,�
State or County License Q0/151-7
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is L7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNE
Nameo_
Address:
City:
Zip:
GINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
Address:
Phone
FEE SIMPLE TITLE HOLDER:
State
__ Not Applicable
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Name:
Addre:3s:
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 or installation has commenced prior to the issuance of a permit.
A. LLXW �*,OkA ItV onak(.s norepzesentation that is granting a permit vvii! auJiori�e the permit holder to build the subject structure
uhich is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
;tructure Plfl.aS-� MffUlt with your Home Owners Association and review your deed for any restrictions which may apply.
consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
accordance with the aPproved plans, the Florida Building Codes and St. Lucie County Amendments.
e following building permit applications are exempt from undergoing a full concurrency review: room additions,
sw�inming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
or�;,3trU(1urE'
(ARNINGTO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
'TWI,,':E FOP LMPROVEMENTS TO YOUR PROPERTY. A NOTRCE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON TIiE JOB SITE BEFORETHE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIVN Y06R LENDER OR AN ATTORNEY BEFORE RECORDING VOUR NOTICE OF COMMENCEMENT."
U n0a
Signature of Cwner/ Lr �see/Contractor as Agent for Owner Signature of Contractor/Licenl`�e Holder
&I, ATE *'IF FLC&K�A
COUNITY
Th, formin "st *i was acmiovvieagt:�doefore me
this i day or 20?
Z___W - _4 by
ska�Dcln 3 1 AALS
Name of person making jtatement.
Per�o nal,y Kn,:?wr, OR Produced Identification
-i'ype oi. ident-ficavor,
Preducbcl
/2 .1 :� /_ /�. . . /I/, /� / z7z
STATL OF FLORIDA
COUNFYOF RMUCI
umem was aicknowledgeci before me
this ay of 1-) 20 M by
5V)CU,UtV1rA J A4-P,-1
Name of person making statement
Personafly Known __ OR Produced Identification
. I ype of identificatiox—
Produced,__
(Signature of N ry Public- State of Florida (Signature of Notarublic- State -of Florida
)V'
;?Ifelkc-1 )Notary P6blic State i
�ntone
Conornission av
h1rey M
N.t.,Iy Pub1',1,State of rooda Ashley M Antonel
'at- -f
Ashiey M Anvo, ;i Ms
).re=o, mv Commission GG
I F - 1 _ " -
?F?. - o"IM;SS on GG '52970
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Expires I TTB77U7T-
REVIEWS
FRONT 1�1
�'0090'014
PLAN
VEGETATION
SEA
COUNTER
REVIEW
REVIEW
REVIEW
DATE
F1 E`
DA E
ev, 2/7/1.9