HomeMy WebLinkAboutBuilding permit appII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
r o r Building Permit • •
Planning and Development Services
Building and code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _-�-----
PERMIT TYPE:
Property Tax M #:
Site Plan Name:
/ v!
Additional work to be performed under this permit — check all that apply:
Mechanical
Electric
Gas Tank
Plumbing
Gas Piping
— Sprinklers
TotGl Sq. F` ct Constw-tion: __`--
Cost of Construction: $ 1 1 4qq- utilitie
Name_ k
Address:
City: [ _._j4X�h Stater
Zip Code _ LM Fax:
Phone No.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Shutters
Generator
Sq. Ft. of First Floor:
s: Sewer ^ Septic
Block No.
Windows/Doors
Roof Pitch
Building Height:
Names "'>'/I11lYla-
Company:AM 94*_p(01f_ of aRAK 4 t A��—�I
Address:110 G TOt11aK44"*- D(y Dom'
City: �►I�.�i,► .ilnrl�►.r✓ P�r.0 State:_r_l�
Zip Code: 3ag3l Fax:
Phone No `77a---
E-M a i I
State or County License Q01-1511
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If vaiue of HVAC is 17,500 or more, a RECORDED Notice of Commencement is required.
Name
Address:
City:
Zip:
GINEER: _ Not Applicable I MORTGAGE COMPANY: — Not Applicable
Phone
State
Name:
Address:
City:
Zip:____ Phone:
State:
FEF .SIMPLE TITL!: HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: _ Name:
Address: Address'.
City: i City:
Zip: Phone: Zip: Phone:
i
i
)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.
it. Luc.if d.ocni\' sr;ak ; no repiesentatior; that is granting a permit vviil the permit holder to build the subject structure
vhich is n conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
tructf_fre Pieas� consult with 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
n accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
"he following building permit applications are exempt from undergoing a full concurrency review: room additions,
rcc.�s„or; structurE s, sw` rming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
`WARNING 10 OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
'TWI=:E FOFt JMPo'ROVE'MENTS TO YOUR PROPERTY. A NOTICE: OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH Y".R LENDER OR AN A,r,rORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
4A'fE ;;IF FL0i.u6;A
COUNTY
The forrolnb ir,sti'uli,erit was ackriowieoged Oefure me
this _ day of , 20_ by
Name of person making statement.
Pe.r�on<l!,v Knnwr• OR Produced Identification
lypr o(: ident fi<at.c; --
Produc'Qd
(Signature of Notary Public- State of Florida )
Cornrnission No. _
;Seal)
� STA u L OF FLt3RI .
C43111,11Y OF
1 foi gjing insti meni was acknowledged before me
this _&_ day of _ I , 20,-k) by
Name of person making statement.
Personally Known —X OR Produced Identification
lype or laentffication
Produced._.
(Signature of N( ry Public- State of Florida )
Commission No
Notary`Pub ic'State of Florida
Ashley M Antonelli
., i•r± � cnn�n
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- oa Expires 10/
8/2021
REVIEWS I FRONT
ZONING
SUPERVISOR
PLANS
VEGETATIOV
o ry
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
FIE., EiV G
DATE '^r—t---------
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coMPL_-_ ED
ev.2/7./19