HomeMy WebLinkAboutBuilding Permit Application II
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�All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)4621-1553 Fax: (772)462-1578 Commercial Residential ^
PERMIT TYPE: C�CzYz"
Address:_ (.n-7 n FL- 34451
Property Tax ID#: 1'7 1(� Lot No.
W�Q,(� (s
Site Plan Name: ZOA PQq-1G- (1�.{�- Block No.!!-7 _
Project Name:
'`•,.:reuz rurRw'•� .,x. st' :1
Additional work to be performed under this permit-check all that apply:
_,Mechanical _Gas Tank ^Gas Piping _Shutters -k4indows/Doors
_Electric —Plumbing Sprinklers ,Generator Roof F tch
TotGl,Sq. Ft c,f C_,Orstru_*ion: _ _ Sq. Ft.of First Floor:
Cost of Construction: $ 'I �• C71� Utilities: y Sewer —Septic Building Height:
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k cV se •�,
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Name G. Name:
Address: 3�Y A NA�LLVUL Company: A�fQ C-_&" i-yeViAW f�ec.(Sf (w__IL
Citv: _�1 Q^I�jQ, State: Address: /(p 13 TGI`hQ.�- b0 Dom'
Zip Code' *SL Fax: City:kla. ,(rhuj, � State:
Phone No. �„ 1 &file Zip Code: 3a9'bj Fax:
E-I`�aii. Phone No -77a-337' ' 70 �I
Fill in fee simple Title Holder on next page( if different E-Mail PJ.h M(a�
from the Owner listed above) State or County License ',1g3t*
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.
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name Name:Address: Address:
Address:
City: State: City: State: _
Zip: _- Phone Zip: - -- Phone:
FEF.SIMPLE TITLE: HOLDER- Not Applicable BONDING COMPANY: le
_—_ pp —Not Applicable
Name: Name:
Andress: Address.
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City:__i City:
i Zip: _ Phone: Zip: Phone:
WNER/CONTRACTIOR 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.
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t. Lucie i;clL rw v makc.; no rep;esentation that is granting a permit vviil auihori�e the permit holder to build the subject structure
11ich is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
tructure Pleas?con-ult A•ith your Home Owners Association and review your deed for any restrictions which may apply.
n 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.
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he following building permit applications are exempt from undergoing a full concurrency review: room additions,
cces::ory St-LJCI ME sw`rnming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
`WARNING 1'0 OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR GRAYING
TWI�_-E Foie LMPROVE'MENTS TO YOUR PROPERTY. A NOTRf.E OF COMMENCEMENT MUST BE RECORDED AND
€IMF TED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
I W IT1.1 YIIr"LENDER OR AN ATTORNEY BEFORE RECORKANG VOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/Lessee Contractor as Agent for Owner Signature of Contractor/License Holder
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61,A'fE 1')F FLOr'o'LAC) STATE OF FLORInf-
-GLIN
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The F��oin6 ir,st,�c it`ar t was acknowic-oged :;efore me 1 ii o ping irstrum ni was acknowledged before me
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this_-- day of J���( 20�by this 1_�day of —,20,90 by
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S1 CA 4n a Lud-eS
Name of person rral ing,,tatement. I Name of person making statement.
Per}Qn,:j!,V Knn,,vr, _ .!v OR Produced Identification Personally Known OR Produced Identification
_._
iyG�< OI ictPnt ikat r.-� 'iype or identification
Prcduri�d _ _ .__._._._ _.. __._... Pro
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/�20WIt411 ZZ4 X2,4,pl ov MA
(Signature of No y Public-State of Florida ; (Signature of Plary Public- ttffe of Florida )
Cornrnission No. � ea C mission �?o.
^sy�� Nota Public State of Florida I — o Y�L�l otary ublic State of Florida
— _ Ashley M AntorteNi —_ �; Ashley M Antonelli
o --Expire 10/18/2021 0
?aFnp Expire 1o/1812021
j REVIEWS FlU ANS VEGETATION a
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW R I W
DATE —
RE_-L:iVEU
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