HomeMy WebLinkAboutBuilding permit appAll APPLICASU INFO MUST BE COMPLErED FOR APPLECATION TO &E ACCEPTED
Date- 5 -r)- _)_
Permit Ntrmbei-
Building Permit Application
Pkinaing cnd DeMcpmenl 5eMcrs
Building orW Code Rqw1a6on Mision Commercial Residential
.?3LvJ Viryoriio Avenue, Fort Pierce FL _:;uMZ
Phone: (772) 462-1553 Fax: (772) 462-1579
PERMIT APPLICATION FOR'
PROPOSED IMPROVEMENT LOCATION:
Address: IV 0
Pr-operty Tax. I D '?,Z) ��Z_6 0 dz� 0 Q L-A Lot No_
Site Plan Name: Block No -
Project Name:
EDETA']LED DESCRIPTION OF 'WORK.
eX, 0 -J� rzad Y"
+
r%o%-i Licc-trical MKer Second Flearical Meter
LCONSTRUCTION INFORMATION-
A<Jdqtion,ativ. orktabeper farmed under this permit- check A that apply:
Osis Tank Gas Piping ,utters Windows/Doors PORCI
-f I L,_ -t r f C: ISI urnblri— Spr[n klnprs Gcn crator Root Pitch
totai Sq- Ft of 0", wtion; Sq.. Ft. of First Flog:
Cost o' ConstTuc114?n-$ UJjliJi42S: Sewer plir; Building Height:
OWNER/LESSEE- CONTRACTOR,,
aNa m e__—re, LA
Address-- 1,40-4
City: QLg �C—Z_ StAt4t': L'l,_
Zip Code: --3Hfl 5
Phone NG-_,
Fill in fft �fnTple Title Holder &nnext page (if different
from the Winer listeld above)
Name:
Company: Awju!c;
City:_ trr_c
State; r-(,
Zip Cb&- N-12— Fax. &
Phone No
IL4E
State ot County License
It valucof constnK:fian is 2SW or more, a RECORDED Notice of conwi tFirwm is requ Fred -
If Value Of HAVC is VSW cw mw-, a RECORIVED "ice of Commencement Jsreq0rej.
I-SUPPLEM.ENTAL CONSTRUCT0N LIEN LAW INFORMATION:
o DESIGNER/ENGINEER, — Not ApplicabI a I BORT-GAGE COMPANY,
N -a n 7e-
Address:_
city." State:
Zip: RhQne
TITLE HOLVER. N cit Ap pi i cab Ie
Na me:
Address=
city -
lip: Phone_.
Name;
Nol Appliia blc
address=
cit' ; State:
Zip- Phone:
BONDI NG COMPANY: —,Nvt APPI i cable
Name -
City:_
Zip: Phone:
OWNER/ CONTRACTORAFFIDVIT. Application is hereby rrkade to obtain a permit to do the work anclInValFairon as indicated -
I certify that no work or instal lafloa his, 0orrim-enced prior to the issuance of a permit.
St ' Lucie Coup rri akes nO Fepfelkntation thA is. granting a permit will autburize the permit holder to bLild the subject .&b da�bfu
wh Ch i-� in conflict with any applicable Home Owners Association rug sr kyoaiw�s or and c
I *ytjw t1h that May restrict ski prohibit such.
structure. Please consult sfikh your Horne Owners AU*Ciatioo and TL-Oew your dead for -any rests ictions which Tnay apply.
an commsabon ofthe- grontOE of this requested permk, F do hereby agree that A wjfJ, in ad Fesp$c ' PeOwm the wm*
inaocwdwCee vn1h the apprcNk plans, die Florida Building Code& and 5L I ude co-unty Amendmi tints.
The following building permit applications are exempt from u(j6erp<;inp p I u; I concurmncy review- room additions,
accessory suucturt-_,, --muimmog pu(?I% f"ce-k, waLir., *nr, screen roorns a rid 3 ic,-ssory use.5 to anottper non=vc'.-WcPtW use
WARNING TO OW NER-. Your failure to Rmcard -a Ketke of rximmerickinent may result in paying twice to
f mprovernents to your property. A. Notice of Commerbcam@ nt must be record ed i n the Pu bi i c -e cords C(f St.
Lucie County and pasted on the jobeita befom the f rst impection. If you intend to obtain. financing, ocin:suft
with lender or an attornev before commencing work or word ins sour N atice of C-ornme nce merit_
Signature of
! FLOM [)A
OF Lt
as
L1_
' FLORIDA
OF
Holder
Sw0 r-med) and subscribed beforr- rrle 01 Swu5w to (cir affirmed) and sub&criteo before ML- at,
75phys' 311 F4e6Pjv4, or Online N otarization / physjc0d .Pre -gine --- On][im JY=ri�mtiion
this �4 Ely AGeo 2020 by this Qay of 21320 by
L.) 011%
Name Of Vinwai m;jkrnr statement. Name of person niakiN =ternlerit
PeyWn;P11y!Knu-L%m OR d uced identNicatiion
Tyrrye,flification
(Slof Not-wV Pu blic- State of Borida
m
No, Gicr_ ALL 9,-� (5ea1i
RT�Vl �WS I FRONT ZON I NG C'Q U NT E R REVIFW
DATE
K!ECF_LVF_D
ti
Personally Known .11-11"CM
Ir, e dcntj fimtion
Pr
e of Notwyr''Pu &C --Mate 4 Florida
Co fission No. 4
P11ANS I VIEGErA-110K I SEATURTLE
Rf VFLW RI'VFEW REV(EW