HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: ao1103'0_1�ln
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
230D Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: (
PROP„OSED.IMPROVEIVIENTIOCATIOfV_
Address: Lol0U-1 S TNDiAN i1Ve2 1JSL 17ie4c!' F1 3ggp2_
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DESCRIPTION OF WORK:
-At1 MnLP Tr%oi4
INFORMATION:
Lime 'To Fi
Additional work to be performed under this permit -check all that apply:
_Mechanical ✓Gas Tank Gas Piping _ Shutters -Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction:$ 1aDO'00-
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name KEAJ WDQTfnJ1jFlLq
Name: .l4n765 e5lw5lev
Address:6603 S.
Company: Y/0✓i2% 6-as g6k&t a
City: H. Re2cC, State: FI
Zip Code: 349 37 Fax:
Phone No. 305- 5,2 r)- 5859
Address:A5D s lear7/i-elv
City: .Slall-l- State: FL
Zip Code: 3y99y Fax: 77=78/-//19Y
Phone No 77 --ZV / 7
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Q r" E D✓/w Q - 0_S. 66rm
State or County License 1-6- S�Jr
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.
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not
Address:
City:
Zip: Phone:
1\�II\IG�/nnwrrn wnrww .
MORTGAGE COMPANY: _ Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
ZIP: Phone:
- --•- • • .�..... „PPucanon is nereoy mane to obtain a permit to do the work and Installation as indicated.
I certify that nttor work or installation has commenced prior to the issuance of a permit.
which is inoconFlicmt with any applicableHome Owgranting ciationi ru es authorizeblr and covvenants that mayd the
trict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming 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 PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOBAIRE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER,01%.AN 4XIbRNEY BEFORE RECORDING VnIIB NnT\rF nF rnmurwrigmCmv"
Signature ofOwner/ LL'ssee/Contractor as Agent for Owner
STATE COUNTWOFORIDA9�n
The forgoing instrunowledged before me
this-dayof a!
2(iZ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
JOSEPH
State of Florida
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this —day Of_ 20_ by
Name of person making statement.
Personally Known d OR Produced Identification
Type of Identification
Produced
Notary Public - State of Florida
Commission N GG I'ONI)
DdyLamm. Expires May PP
Banded thragh Aatianalklir,Am.
REVIEW I VREV EWON I S REV EWLE I M REVIEW