HomeMy WebLinkAboutBuilding Permit AppI APPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
4
COUNTY
� � a D A
Plohning and Development Services
Bui6ng and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
1 if
Building Permit Application
Commercial Residential 9�
Address:` 3 �_
Lot No.
Pro} erty Tax ID #:
Block No'.
Site Piari Name. _
Additional work to be performed under this permit - check all that apply:
Mechanical — Gas Tank Gas Piping — Shutters
Electric — Plumbing _ Sprinklers — Generator
Sq. Ft. of First Floor:
Tol Sq.
cost of Construction: $ f 0 D�- n utilities: Sewer _Septic
�cldressr��
State: RZ
Zip Code: --�� . -- Fax:
Phone No. `77_
Fill in fee simple Title Holder on next page ( if different
fforrl the Owner listed above)
Jz/W1ridows/Door5
Roof Pitch
Building Height:
Name:
Company: 91A elKca t�L ik, ei f5�
Address: 1 C3 Dr"
City: _kt tl1A.eLc(I _ State: L
Zip Code: 23"f t-?�i" Fax: ��7"4a3+_ ,
7n
Phone No "1"7 a�
E-mail
State or County License
if Eue agJ oe�,trucrion is2500 or r►aore, a RECORDED Notice of Commencement is required.
If value of HVAC is },7,500 or more, a RECORDED Notice of Commencement is required.
I
""Rip"W"MORTGAGE
COMPANY: — Not Appiica�ie
Name;"
Name:
Address:
Address: _
City;' State:
City: State: _
Zip _�w._..._._...__._. Phone -------
Zip: .,----- _ Phone:
FE5SIMPLE TITLEHOLDER-. _-- Not Applicable
BONDING COMPANY: Not Applicable
NaMe:
Name:
— _.
ALidress:
Address' !
City:
Zip: Phone-
zip: _ Phone:
1A NER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as'ir,idicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
i
t. �uc:iE: ,o ntiv rr akzs no `epresentation that is granting a permit will au[horize the permit holder to build the subject structure
Association rules, bylaws or and covenants that may restrict or prohibit such
hich is ;o cunflict with any applicabie Home Owners
trust?ire Ploas,� convult wr th your Home Owners Association and review your deed for any restrictions which may apply...
n con sideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
n acc6rdance with the approved plans, the Florida Building Codes and St, Lucie County Amendments.
he following building permit applications are exempt from undergoing a futl concurrency rev}ew: room additions,
rooms and accessory uses to another non-residential use
ccas dry structures, sw'.rrming pools, fences, walls, signs, screen
`WAg2 NING 1-0 OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
AND
Fop 9m-pR(AvEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED
7yp-E
P-O5aTED ON TIIE JOB SITE BEFORE 'THE FIRST INSPECT90K. IF YOU INTEND TO OBTAIN FINANCING,. CONSULT
I
Wilt H T 01i. R LENDER OR AN ATTORNEY BEFORE RECORI? NC. YOUR NOTICE OF COMMENCEMENT."
-- --
Signature of Owner/ LP.s.see/Contractor as Agent for Owner Signature of Contractor/License Holder i
5 i�t :: Ff.C;ku6 A STATTL OF FLO.
COUNTY � f13li�I IY OF�
Thy''. �r�;oir b ir.st i }r crrt was ackhr,' ieaged 'uefure me i"41t� I I' mg iristr eni was acknowledged before me
Isday 20 1 by
this day of_ -� 2(}— by this of , E
i
i
game of person rraking statement. Name of person making statement.
.;,
pertibrihiliv Knnwr OR Produced Identification Personaliy Known OR Produced Identification
l-yr++., 332 rdent I" tl,- -- I i'ype ar tclentificatlon
Prceitic: d
(5ig'y,9ture of Notary Public- State of Florida ; (Si nature of ary ubNc
4' I
r 10 Notary Public State of Florida
Ccm.rhissi(an No.{Seal) Commission No. A4$�Antonelli
y; My Commission GG 152970
E of cti� Expires 10118/20�.1
RE.:VIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW j
�I
DATE
fkcE: i V Et
DATE --
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