HomeMy WebLinkAboutLam. E AppII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date-'
Planning and Deveiopment Services
Building and Code Regulation Division
230gVVirginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PER, 'MIT TYPE:
Building Permit Application
Commercial _ Residential X
Address,. 0
Lot NO.—
PropertyD � • 1� rlr r� 1 •
Block
site ■
• • del!
Additional work to be performed under this permit cnecc a�i zna� d�,N�y.
Mechanical Gas Wank _Gas Piping _Shutters
Electric Plumbing _ Sprinklers Generator
Totq`I Sq. F': o`
Cosf.of Construction: S
Sq. Ft. of First Floor:
Windows/Doors
Roof Bitch
utilities: Sewer — Septic Building Height:
Address: -
CiT� State: Pl—
Z11P Code:') Fax;
Phone No._?�5-�_439- Q21
Fill in fee simple Title Holder on next page.( if different
from the Owner listed above)
Name:
Company: MIA S R
Address: Ift3 s �r►ahat
City: a��CL, State jj:
Zip Code:3?, b - Fax:
Phone No -7-7 —
E-MailA4A.' tA�r eflC z �_
State or County License 1_7
L-_._—...-•
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required,
If value of HVAC is g7,500 or more, a RECORDED Notice of Commencement is required.
NGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
'City:R`" State:
Zip: _.. --- Phone -_—
FEF �..,IMPLE TITLE: HOLDER: _-- Not Applicable
Nary; : ---,-
Addr.Os:
city:
Zip: ' Phone:
Address:
City:
Zip: _ _._ Phone:.
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
State:'
Not Applica:hle
)WNER/ 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.
It. LLA6.0 CO,;OW MRkL.s no representation that is granting a permit will auihocize the permit holder to build the subject structure
vllich i , in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
trurtul�e Plr�as consult With your Home Owners Association and review your deed for any restrictions which may apply.
n consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
n accarLdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
-he foilbwing building permit applications are exempt from undergoing a full concurrency review: room additions,
rcc.�s: c r;F structA ire,s, sw:mrning 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
''I wl,,,,E FOR tMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
p06TED ON THE J013 SITE BEFORE THE FIRST INSPECTIONIF YOU INTEND TO OBTAIN FINANCING, CONSULT
W1*H 10iiR LENDER OR AN ATTORNEY BEFORE RECORIDiNG YOUR NOTICE OF COMMENCEMENT."
Siger/ LessAgent for Owner
STA'tE uF FLOi-.
COUNTY OLF
TheefY ,Fin8ir"St'i' iiidDI'w-M,eogt_-d'oe'foreme
thisCP day of asa01VVfa021 by
Name.of person rr.aking statement
?l`V Knnwr OR Produced Identification
identficatkc: ----
(Signature of N r>I Public- State of Florida)
Comhnission Nio.w-(, _
a°�Y P. Notary Public State of FiC
Ashle M Antonelli
ay My C mmission GG 9525
REWEWS FRONT" .f i #G Fxpir.s5t fflftftSOR
COUNTER
DATE
_RE.'��iVED
DATE -W,
Signature of Contractor/L ense Holder
E 5TATL'' OF FLOC
thismi ing irist menr was �CknowledJeefore me
dayof , 2by
Name of person making statement.
Personally Known OR Produced Identification' _
i'ype of identification
Producer
n I' /?
(Signature of N aarV Puubll--ic-��M,,aat�te of Florida )
mission No. 6&6;R*7A
Notary Pub€ic State of Florida
— ti
Myy Co mission GG 452970
NS VEGETATION k TWire 1MA=ROVE
EW REVIEW