HomeMy WebLinkAboutKahn Appl APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
Building Permit Application
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:
Address: O� Travel-�s
Lot No.
Property Tax ID #: Block No. —
Site Plan Name: -.
Additional work to be performed under this permit - check all that apply:
_Mechanical `Gas Tank _Gas Piping _
Shutters —, ve-W/Inclows/Doors
Generator Roof Prtch
Electric _, Plumbing _Sprinklers _. —
Tot6l Sq. F` c` Constru-tion: __---
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
Name__
Address: (Q(71q "TVt�NGI'e-� Wa Ae
Cit is 1�4X_Cl� - State:
- _..
Zip Code: _� M Fax:
r �( 1Qia�7
Phone No.-1-1_.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: G
Company: WA 9AV-P(LSG o4 T�realardL f�A ReclSicw tc
Address: Ito 13 Temal% JIL Df`
City: hl�(�l� ��^�✓ P�i�ch, State: rL
Zip Code: Fax: 3.1t1423AL_..
Phone No -7-7
E-Mailga a�IFLtS��^r�rx'►1t'�
State or County License QQ''')i'7
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.
DESIGNER/ENGINEER: _ Not Applicable
Name
Address:
City:
Zip:
Phone
State
MORTGAGE COMPANY: — Not Applicable
Name: _
Address: _
City: State: _
Zip: -___-_— Phone: _
FEE .SIMPLE TITLE,: HOLIDER: Not Applicable BONDING COMPANY: Not Applicable
Name: _ Name:
Address: � Address
City:__ City:
Zip: —_ Phone: Zip: Phone:
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 of installation has commenced prior to the issuance of a permit.
>t. Luci< mak<; no -e{lresentation that is granting a permit vviil auifioi ire the permit holder to build the subject structure
Nllich is ;n conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
itructure Pieas� consult with your Home Owners Association and review your deed for any restrictions which may apply.
consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
e following building permit applications are exempt from undergoing a full concurrency review: room additions,
-�s•wr stuc:l.!.ire:;, sw"corning pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
IARNING TO OWNER: YOUR (FAILURE TO RECORD A NOTICE Of COMMENCEMENT MAY RESULT IN YOUR PAYING
'TWI',::E FOR? IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON T11E JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
M'iYH YOUR L€NVER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner I Signature of Contractor/License Holder
Ct)t.JNFY �---
The r;omr, ir'st r,cnt was c,cmiow,eag d Lefore me
this day of — 20 by
Name of person rraking statement.
Perconz ! y Knnwr, OR Produced Identification
Type of. ident•ii, at+
Prcducir,d
IA111a IIAi'
(Signature of N� ary Pub =o Yes-f ra blic State of Florida
Ashley M Antonelli
My Cpm_r� kssion GG 152970
Comr-nission No. 6! 46 Expil'e�'•0018/2021
STAT'i: OF FLORI •
S:.hlt.lH FY OF
1 i'u {oi g,)ing insti ment was acknowledged before me
this _ day of_ 11 QflJJ0W 20,* by
Name of person making statement.
Personally Known _ OR Produced Identification _
type or identification
Produced_- _
(Signature of NVry Public- State of Florida )
Commission No ( %�aa1
=o �•`fi Notaryubli State of Florida
Ashley M Antonelli
1•c 1.1—
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oaoa• 'Expires IO
812021
REVIEWS I FRONT
ZONING
SUPERVISOR
PLANS
VEGETATIO
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
PIE* U
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2/7./ 7.9