HomeMy WebLinkAboutBuilding Permit ApplicationII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address: _ _ �1A 0 04, SIR SS r ' r-
Property Tax ID #: 14— -701— -12r'x�—�� �� Lot No.31
Site Plan Name: V 0 0 J' S cov, I'Block No. 1(p --
Project Name:
Additional work to be performed under this permit —check all that apply:
Mechanical Gas Tank ` Gas Piping _ Shutters _XWindows/Doors
Electric _ Plumbing _ Sprinklers
Total Sq. F`. of Consrruction:---_
Cost of Construction: $ 9,1415
Name
Generator Roof P+tch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Address: 91!�7x Wtya TiY0,4. C. n
City: _&�,, ._ _ State:
Zip Code: ( Fax:
Phone No. 3a i--. R- (023(0
E-1✓laii.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:sXl=t7fla_ _WWI
company: 9kk GT11?r;I,1,G of T�reUQ4 W R-gt 510- durOld
Address:1D 13 TOI'hA,kWV- N" Dom►"
City: I Stater
Zip Code: 3291jl Fax: 3;t(-7r'14a34
Phone No -i%a-107- Wf70
E-Mail 'qj.l,(,r,SfO�r�e[�C•t1t,-{'
State or County License Q01'517
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is y7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name.:
Address:
City:
Zip: Phone_
FEE.SIMPLE TITLE HOLDER:
Name: _
Address: -
City:__
zip: — Phone: —
_ Not Applicable
State
_—_. Not Applicable
MORTGAGE COMPANY: _ Not Applica', le
Name:
Address:
City: State:
Zip: Phone: _
BONDING COMPANY: Not Applicable
Name:
Address*
City:_
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.
>t. Lucie i:oJnty makr., no representation that is granting a permit vyiil auihorize the permit holder to build the subject structure
v!tich is n conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
;tructure Pleas? 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
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,
�s,=orj structArre c, sw`rrrnirlg pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
(ARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
•9'1'rFX FOR IMPROVEMENTS TO FOUR PROPERTY. A fNOT9CE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE .JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
wAvu Vr%k D : CIVNIwCt n93 Aru ATTORNEY BEFORE RECORnING VOUR NOTICE OF COMMENCEMENT."
�A '
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Signature of Owner/ Le. see/Contractor as Agent for Owner
Signature of Conti for/License Holder
S;-,ATE ;;F FL01- K;
STATL OF FLOWPA
COUNTY �t _-.
L.OUN FY OF rhnnfaAd _
The f rr;oing Ir,str it an! .° aCRriowieaged oefore me
this day of 20�by
li e t +going ir,str ent waLsa nowledgeo before me
this � day of 2V by
elm 1 �t f 1 /�
Q,uX1 Din
Name of person rraking statement.
Name of person making statement.
Personally KnnLyr, OR Produced Identification
I Personally Known OR Produced Identification _
i yp<, o } (dent ficatic-
, Type of identification
,.
Prod d. _...._
Produce
r
Signature of N- ry Stat of Florida ;
(Signature of Not Public- State of Florida )
T-
CornrliSSic>nfro. �Y"tq�(SQ ry Public State ofRon
b'r-o issionNo.i5
Ashley M Antonelli
, "(,*, Notary Public State ::•
My Commission GG 15297
f A tnn L:
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es 2021
., • My
Commission GG ' °
REVIEWS FRONT
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VEGETATION
S A'fMLE e«
"T�IA9VG VE
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
DATE
RE�EiVEG
__--
DATE
COMPL
2/7./ 7.9