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HomeMy WebLinkAboutPons AppII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 3 _ Permit Number: Date i Building Permit Application Planning and Development Services Building and Code Regulation Division 2300, Virginia Avenue, Fort Pierce FL 34982 PI?ane: (772) 462 15s3 lax: (772) 462-1578 commercial Residential rse Additional work to be performed Linder this permit- check all that apply: Gas Tank Gas Piping Shutters Mechanical — — Electric Plumbing Sprinklers Generator Total Sq. F` of Crins�:rta:*ion: _ �_ _ Sq. Ft: of First Floor: Cos.' of Construction: $ �/ 3�©• E�f� Utilities: _Sewer _Septic state: ip Code: Fax Phone No. ,- 35�� sa3D - Fill in fee simple Title Holder on next page ( if different fi"om the Owner listed above) %Windows/Dorrs Roof Path Building Height: Name: � Company: �' OW Address: l 6 a biry D City: _ State:� Zip Code: 633bl - Fax: Phone No E-Mail " r State or County License Q - If iue cif- construction is $2500 or more, a RECORDED Notice of Commencement is required. if VaWe ofWAC is ,0,5C0 or more, a RECORDED Notice Of Commencement is required. j. az u Not Applicable MORTGAGE COMPANY: _ Not Applic2ll-le Name: Address - City.,: State: Zip _.._....._-.-. Phone FEE SIMPLE TITLE: HOLDER: �_. Not Applicable Name: AUdmss: Cifiyi - ZiP., Phone:_ Address: City: _ Zip: Phone:. BONDING COMPANY: Name: Address: City: Zip: — Phone: State, Not Applicable JVl NER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of a permit. ;t. uc E t'.o<< v makc-s no rep: esentatior, Thal- is granting a permit will auihoi'ize the permit holder to build the subject structure vl-iich is n conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such ;tructtare Pieas-� consult w4h your Home Owners Association and review your deed for any restrictions which may apply.,: n codsideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work In ac rdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. the 6!5 Iowing building permit applications are exempt from undergoing a full concurrency review: room additions, accas,:''(rry struc:t!trr•s, sw'.II pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use `WAANtNG TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING V$zYE FOR EhIPROVE?MENTS TO YOUR PROPERTY. A NOTWE OF COMMENCEMENT (MUST BE iRECORPIED AND Fj[P$TED ON THE JOB SITE BEFORE THE FIRST INSPECTRON. IF YOU INTEND TO OBTAIN FINANCING, CONSULT occr•"M ocrr9ff3k1 !' 'VnW I6 IlUnTar F nF f'.[7mm IY r-fi1T_- Signature of Owner/ essee/contractor as Agent for Owner Signature o€ Contraeto License older 51"ATE F F"LCn' OF STA T it i � COUNTY is �'The f, #r.a ll'strt ! �n+as L" day ac t�c,WIIC-08 d '..eftire nee 20,! by i,i.,e f r ping mstr meny was a knowiedged before me this day of 20 by � ; this of —�, .._, Jana - Narn;e of pperson rr�aidri 6 .sf�s tement. - Name of person making statement. �tmi!!;v KnnLvr' OR Produced Identification Nersonaliy Known 1 CAR Produced identification k.. ,. , 'iype or identification Pra`-ot Procfu d._..._.. (Si&�ture of Not y Public-tTiate n Florida ; Sgnature of ar Public- tate of Florida ) V; ti Comrnisslon No, � Commission o. p ` Pik Notary Public State of Florida Ashley M Anotoneili 4T _901I� .c 4 Notary Public State of Fiords Ashley M Anfonelli _01 pa x i s 101131 0 oM o4 Expires 1011872021 RF.VIEWS FRO i�` RVISO PLANS VEGETATIO R COUN = I� f REVIEW REVIEW REVIEW R I ' —� DAB E RD-E: V Ei: DATE