HomeMy WebLinkAboutpermit app for 28 montoyaAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (`oZ." :i.3 - Permit Number:
s`- Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: &IS �o�►�vo.
Property Tax ID #: _ Lot No.
Site Plan Name:
Block No.
Project Name: (;,�,,-�-�v A f Iy i (Iq4 i°
DETAILED DESCRIPTION OF WORK:
h
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _Windows/Doors
,C Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ _� 1 r1trp . iv Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name vnn.� 8u � (o�t'rza rD Name: oun,rr; si`iwp%t✓ Sexin 4 rl
c
City:Address: pop U� s? �02 Company:firL ftlo.s�Br Elae ran L .
City: P,,,+ Sf Le�Gio State: FL Address: 1646 $W M&C,AK 1+Ve-
Zip Code: 3K4S� Fax: '2?-. -;ZOO{ - 2! �(� City: &t Si Cuci e_ State: .
Phone No. ?Z1- ir% Sl- .3f'
a I I Zip Code: 3LiRS 3 Fax: ?72- 20y -.2190
E-Mail: Gy,Gt 5 �next
sPhone No ?72- 70r- Tq„6Fill in fee simple Title Holder on page ( if different E-Mail_ C kf ®� pa.r%� s�• la(Ccs - torh
from the Owner listed above) State or County License FQ. 3 175 1
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.
.-PLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNE
Name:_
Address:
City:
Zip:
NEER: __�_ Not Applicable
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:_
Zip: Phone:
State:
_X_ Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
�C Not Applicable
State:
Not Applicable
UW NtK/ LUN I KALTUK 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.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict 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 I 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 FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS 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 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Co ractor gent for Owner
STATE OF FLORIDA /� J9 J f
COUNTY OF
The fo ing instrm n as a <no ledged before me
this�day of 2W by
Name of person making tement.
Personally Known OR Produced Identification
Type of Identificatio
Produced,
ature
Commiss
UM"MINT10Floricla)
NOTARY PUBLIC
STATE OF FLORIDA(Seal)
.� .:,. •r,.r,lr
i
Signature f Contracto License H,6ffler
STATE OF FLORIDA
COUNTY OF
The foGrgQing in t was •kn wledged ore me
this 7'/�ay of 2 y
Name of person m7OR
tement.
Personally Known Produced Identification
Type of Identification
Produced
of
Commission
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OFFLORWItSe a 1)
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PLANS
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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