HomeMy WebLinkAboutBuilding Permit ApplicationI) APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
COUNT
F L .4 K 1 D A
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-:.553 Fax: (772) 462-1578
PERMIT TYPE:
Building Permit Application
Commercial Residential I ----
Address: ?j?JOa.V Oihli �j , �I�•I�t1� J�i�'
G� Lot No.
Property Tax ID #: _ 4D� �D Day x$12 --1
Block No.
Site Plan Name:
v S _
Drnic.rt NAMR:
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 o` ConsrW--tion: _ _ Sq. Ft. of First Floor: —
Cost of Construction:S ' a- Utilities: —Sewer _Septic
Name �-
Address{ ��p�i . eju 10
Citi: _L�L�'r._..1._I-Q/�' �p� State:
Zip Code: ft Fax:
Phone No.�]
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
A/Windows/Doors
Roof P tch
Building Height:
Name:minitwin , UffKw
Company: 9kk &TIErp(le, o4 PX-eAKMA W ReaStcw «r�R
Address:OW
(ID 6 1Ql%P-k,4nA� D�` D
City: State:
Zip Code: 3a9'j1 Fax: 3at��1"1"P'`�a3►_
Phone No -7-7 a-337- 41VO
E-Mail&JA 17�lel.CSfOYLr�t�•(1t%
State or County License Qcl-)17
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of MVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
ida
DESIGNER/ENGINEER: Not ApplicablelMORTGAGE COMPANY: Not Applicable
Name ame:Address:
ddress:
City:_ State: City: State:
Zip: ---..._..-_....___ Phone--,--- Zlp: ___--- 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 clothe work and installation as indicated.
certify that no work or installation has commenced prior to the issuance of a permit.
A. Lucie ,.001ty sr;ake.; no representation that is granting a permit vviif auihorize the permit holder to build the subject structure
inch if. any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
n conflict with
tructure Please consult 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
n
n accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
he following building permit applications are exempt from undergoing a full concurrency review: room additions,
cc-s=orV Strutt urE S, sw'.trrnirig 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 GRAYING
TWI X FOP LMPROVEMENTS TO YOUR PROPERTY. A NOTC;S:E OF COMMENCEMENT MUST BE RECORDED AND
P1135TED ON TI4E JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOirR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
ST,4TF OF FL AL
�
y�" T EUN Y FLCr.u�--
COUNTY �.:;- --- - -- wi`3JNI'Y OF
The ftrgoing ir,strt.rnar : was acicnowic- aged oefure mel i e fol ging instrument was a knowledgeo before me
k 20_W by this day of 20VZ)by
_
this day of _.
Name of person rraking state—mfent. I Name of person making statement.
Persorial'y Knnwr,. _- OR Produced Identification Nersonaliy Known — OR Produced Identification
iwe of ioenvficat.c:-, I iype or identification
Prodw-`. i Prodw eM.
gnatilre of N any a I;c State of Florida ; ure of No ry blit State of Florida
Commission No. �?� �� _ _ ' otary Public Stale of Fl�rida
�*" eat{ Com scion No.(`�E
- - � Ashley M Antonelli
GG 15 970 Notary Public
My Commission State of
"_ ires 10/1812021 M A
X�l
I�
r
FRONT II
SUPERVISOR
—Ashle
PLANS
VEGETATION
SEECOUNTER
y omm ssion GG 1 2REVIEWS
REVIEW
REVIEW
REVIEW
REVIEW
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DATE
RECEVEC`
DATE
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