HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Bu#P ng and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Ph8ne: (772)462-1-553 Fax: (772)462-1578 Commercial _�� Residential
PE'R'MITTYPE:
�Address: 'b-TVa_ l 11W(-i k I A 405 -k PrPXCY 3 ��
Pr4'4_,rty Tax iD Lot No.
5ite,Plan Name: h Block No.
Pro Eet Name:PI-SC
lip M
Additional work to be performed under this permit-check all that apply: /
Mechanical, _Gas Tank _Gas Piping —Shutters V Windows/Doors
Electric _Plumbing Sprinklers —Generator Roof Pitch
Toti i Sq. F:`0 Cons ru:*icon: 5q. Ft.of First Floor:— -
Co,,t'of Construction: s Utilities: Sewer Septic Building height:
N,,'ne� _ Name:
¢u�
At dress: � I'yeryNP.A- Dh Company:'lullJ, pG a� 1?�etiCtr�T l`�t,!°S�ih., uu
Qty: sm 'r_.. ._._ State: Address:lip 13 T2jh �k- b('r D&"
Zip Code: 3 {Q7`3[r, rFax:- - City:_� j4a4'_ ,r )A. >�&ckU , State:�L
Pfione No., ]L. "!gc Zip Code: 3ag-bi Fax: —
li
Phone No -7-7 A-337- 41M
Fill in fee simple Title Holder on next page{if different E-Mai€gl.IA.'( s 1r' rj& ft(-(V+
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4hom the Owner listed above) State or County License Q-q!jl'7 I
If uaYue of construction is$2500 or more,a RECORDED Notice of Commencement is required.
.If uaiue al HVAe is$7,500 or more,a RECORDED Notice of Commencement is required_
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nF_1ir,'NE'R/ENGINEER: — Not Applicable MORTGAGE COMPANY: Not Applicable
Name Name: —
Address: Address: W
Cit} state: City: Stat -
e° ;
zips_ �_...-.._-, .._ Phone — Zip:.- Phone'. -
FEF'SIMP'LE TITLE HOLDER: Not Applicable BONDING COMPANY:
-- pp _ Not Applicable
N a r e: Name:
Address: Address:
Cif y;` — City:
Zip; Phone: Zip: Phone:
-41
ih NER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and 'installation as irJicated..
I certify that no work or installation has commenced prior to the issuance of a permit.
A. Lueia l'0011v Mal L�no representation that is granting a permit wiii auiftadze the permit holder to build the subject structure
Ncli>i'i,n conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
tructUre PIFas's MISUlt with your Home Owners Association and review your deed for any restrictions which may apply.;
n cor�sideration 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.
i
he fdllowing building permit applications are exempt from:undergoing a full concurrency review: room additions,
ccas '0r,!Structures, sw'mming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
`WAONlNC -ITO O WNEW YOUR FAILURE E TO RECORD A NOTICE Of COMMENCEMENT MAY RESULT IN YOUR PAYING
TWO,CE FOR ihIPROVEMENTS TO YOUR PROPERTY. AilOTICE OF COMMENCEMENT MIDST BE RECORDED AND
PiiF5TED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCJNG,i CONSULT
WITH TOILrR LENDER OR AN ATTORNEY FIEFORE RECORKANG YOUR NOTICE OF COMMENCEMENT_"
-.444W A4 400
5ignaturp of Owner/Lessee/Contractor as Agent for Owner Signature of Contract r/#ic,nse Holder
C0.U414,'''01 ---.._... Coru?4 FY OF
The'<For};oir, if"st-p ,,.was Arcwieaged oafore me 1'0k� forgoing instrument was acknowledged before me': i
this` day of 2a by this day of (][tr� 20IJ by
__,___.,
Name of person rralanb.staten en Name of person making statement. !
Per.1o.n',; v Knnuvr ..- OR Produced Identification Personally Known OR Produced Identification
_...._._. PYP'
Pro,r `t f�Prtt!i"irat: r identification
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( ;g ,attire of N ry i lic-State of FI r a , Ignature of Lary t,ubIic- tat,of Florida J
coninlission kwo,f Commis ion No. i
I �y ay Ashleotaryy M A State of F3orida �r°ua Notary Pubfio State of Florida�_—— Ashley M Antonelii o
Fm Expires 10 1812021 M Cam ission GG 152970
i REMEWS FRON I 5 l PLANS VEGETATION �fR-Waes olq ANGROVE
COUNT- E I E REVIEW REVIEW
DATE
R&CLNEV
DATE _ _COMPLFTED
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