HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MU51"BEtbWLETED
OR APPLICATION TO BE ACCEPTED
Date: _
2020, Permit Number:
- , ounty, Permitting
W_1
-
Building Permit ApplicationL:AP:R2
Planning and Development Services
Building and Code Regulation Division :32020
2300 Virginia Avenue, Fort Pierce FL 34982Phone:
(772)462-1553 Fax:(772)462-1578 Commercial Residentitt ng
PERMIT TYPE: SSG—� 64�
ASED iISJIP.R r NR = CATI',P
Address: Sl96' I.V E L 7'O P 7-M.4 J t;
Property Tax ID#: ��)+-q?]g2^00(zJ-pC1p�p
Lot No.
Site Plan Name:
Block No.
Project Name: _
Pro1 Ac. />r nl � .QtC .� Y CTr?c, C a R Y
IL a IPa 10 Oltlli( „xa
�
D�E'sV S�g k? its/ R.4 ' 40.E W Z 0 !o
G- e712 f
�OSTRi OIV'(NF0214A i1p w
Additional work to be performed under this permit -check all that apply:
—Mechanical — Gas Tank Gas Piping _ {
— P g Shutters
— Windows%Doors
y
—Electric —Plumbing —Sprinklers —Generator ✓Roof N Pitch
Total Sq. Ft of Construction: / ,.egg,.eggSq. Ft. of First Floor: / -f O i
Cost of Construction: $ a C O 0 r ® 6 Utilities: —Sewer —Septic Building Height: %
r r ,
Name /V Name:
Address: 6;,;; 1EC-`TdP zf...01A Company:
City: 0':�'7-, Pi elf CG State:iv Address:
Zip Code: A3Je 9s( Fax: City:
State:_
Phone No. G . Zip Code: Fax:
E-Mail.✓^ :, dZs ,49 OWD zSgzPhone No
Fill in fee simple Title Holder on next page ( if differe E-Mail_
from the Owner listed above) State or County License
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.
AE E TALC :. SI , iJ
IIO i tEA'1;
R4Ili,
DESIGNER/ENGINEER: _Not
Applicable
MORTGAGE COMPANY:
Not Applicable
Name: &�RQn , Cirri
aAt
Name:
Address: P, a i3Dx S'G i b
Address:
City:
State: A-c—
City:
State:
Zip: 34CoS% Phone %72_
2is'r• jG 2 3
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _
Not Ap licable
BONDING COMPANY:
Applicable
Name: bbf/ N�^�Q� �Jl��:
1
Name:
_Not
Address.
Address:
City:
City:
Zip: Phone:
Zip: Phone -
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that nttoo� work or installation has commenced prior to the issuance of a permit.
which is into %icmtawith anyappliccablelHothat
e Owners Asssociationl rulesabylaws or and covenants that buildthe
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 1 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 FARURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR ZoMBANIATTORNEY
TO YOUR PROPERTY, A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
PO ONITE FFDRE THE FIRST INSPECTION. IF YOU WEND TO OBTAIN RNANCING, CONSULT
OUR BEFORE RECORDING YOUR NOTICE OF COMMENcEMENT'-n
as Agent for Owner i Signature of Contractor/License Holder
STATE OF FLORIp�4 f STATE OF FLORIDA
COUNTY OF 'J� L� (t,� COUNTY OF
The forgoin nstr mentyras acknowledged beforebeme
thi da of 1 2
lam\ -n2-t-i
Name of person making 4literneilit.
Personally Known OR Produced Identification r/
Type of Identification
The forgoing instrument was acknowledged before me
this _ day of 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature (Signature of Notary Public- State of Florida )
,0,,, I,�n KAREN S. NIELSEN
Commissio :state of Florida-IN(Seal) public Commission No. (Seal)
mission # GG 207484
My Commission Expires
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