HomeMy WebLinkAboutBuilding Permit AppINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit Application
Planning and Development Services
Bui ding and Code Regulation Division
2360 Virginia Avenue, Fart Pierce FL 34982 Residential
Fho,ne: (772) 462-1553 Fax: (772) 462-1578 Commercial
PRMiTTYP G�Wa*
Addr.�ss: ��_ L Vti
Lot No.
Prtr ,Tax 1i3 #: Block No.: L
o� .
Site;Pian Name:
Proj0ect name:
Ad�fitior:al work to be performed under this permit — check all that apply:
Mechanical — Gas Tank Gas Piping
Shutters
Sprinklers Generator
Electric —Plumbing
Cnrts�ru;*ion:
Scl- Ft. of First Floor:
TaLl Sq. F.' Cf
Co`St of Cortstruction S Utilities: —Sewer Septic
State:
Zip Code: ,]-(0- _ Fax:
Phone—
i'�aii. -_
F,,jII in fee simple Title Holder on next page { if different
Pram the Owner listed move)
v indows/Doors
Roof - Pitch
Building Height:
Name:
Company: iu1111 F rTK�SL ,? Pxe�� l
Address: lla 6 Dov
City: _ Stater
Zip Code: 3a. Fax:�—
Phone No :L-7 --1-3`�- 41 _-.
E-Mail,5
State or County License ! -
If value taf� construction rs 2500 or more, a RECORDED Notice of Commencement is required,
if raiue of HVOAC is t17,SC0 or more, a RECORDED Notice of Commencement is required.
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Na.
Ad
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Zip
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I ceri
Not Applica
State:
_- Phone—__
PLE TITLE. HOLDER, __ . Not Applicable
ess:
MORTGAGE COMPANY: ^ Not Applica`;Jle
Name: _
Address:
City: State.' —
Zip:._. — Phone: -
BONk)ING COM€'ANY: _Not Applica ,fle
Name:
Address: _
_ City: —
Phone: Zip: Phone: _
II CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
that no work of installation has commenced prior to the issuance of a permit.
t. �uri�: i:a�r tv ma4(-,.s no representation that is granting a permit wiii auihor iie the permit holder to build the subject structure
ov
tructUrenPlrfasl? c with any
�YthpypoiurHlome Owners Association andrreview�your de d flaws or anor any restrictions s whhat may ich maor
apply Ibis such
In coi4pideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
n acc6ance 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,
rcsw'.mrning peals, fences, wails, signs, screen rooms and accessory uses to another non-residential use
'WAR1414i1 G TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
'TWStYE FOR IMF R[i�E1ViENTS TO YOUR PROPERTY. A NOTME OF COMMENCEMENT MUST BE RECORDED AND
RLF!5;irED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
Wil-Cli YOL iR LENDER OR AN A•i"rORNIEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of owner/ Lessee/Contractor as Agent for Owner
STATE E F'LOreGL;A
COUNTY �31F_
The: 1`13r�,oing ir, Stria! i �i ' Wu5 8i hrYG Wi@Q�t f bfUrQ nl�
this i` day of 20_ by
Nan"e of person rr•aF6rig statement.
E
Per. nbmlliv Kngwrr _.. OR Produced identification
Typ!;oi idenvfir.atior,
Prc�4o' ' id - .._-..__.T._....
x
(Sig gatmeof Notary Pvblic- State of Florida ;
Con';linission No. (Seal)
RI VIEWS FRONT ZONING SUPERVISOR l
I COUNTER REVIEW REVIEW
BATE
DATE
CONAPLETFr.)
Signature of ontra or/License Haider
_STATL OF FLO A
j -COUNTY OF
l hte for oi'rig instr menr was acknowledged before me
this _J� day of 20& by
Name of person making statement.
Personaliy Known ff ,. OR Produced Identification
Type at Fdentiflcation
{Signature of NAary Public-
V AnY pL&� Nat Pubiic'State of
Commission No. f ( y h! Antonr Ili
c My Commission GG 1
...red Expires10A8J2021
PLANS I VEGETATION SEA TURTLE I MANGROVE
REVIEW I REVIEW I REVIEW REVIEW
o�qe °ua{ Notary Public State of Florida
� Ashley 1N Antonelli
GTVr Expires 1011812021