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
Building and Code Regulation Division
2300.Virginia Avenue,Fort Fierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial - Residential
PERMITTYPE, jx4AC i,lt
Address: 4;l-�
Property Tax ID#: a3 --I)3-- E Lot No.
Site Plan Name: .2dim4.1rd Block No.
Project!game: _ �_♦�`3p
Additional work to be performed under this permit-check all that apply:
Mechanical _Gas Tank Gas Piping _Shutters Windows/Doors
Electric T Plumbing Sprinklers Generator Roof Pitch
Totall,,Sq. F' u:::of Cons _ Sq- Ft.of First Floor: �...
Cost of Construction: $ 't�, a�af�- (]�� _ Utilities: —Sewer —Septic ' Building Weight:
c h
Na e ' Name:
Address: 49A5 3- h1�rl& );Uv"-D! '• Company:MA p(6k I Beuu A W �ecCSI A'15L& ,
Cite: _ State: jai Address, Ito E3 T I'1'tA i.Wk- bf'
Zip Code:_3����' Fax: City:�d���a�r ,� E,tP�c�ti, State:
Phone No. 'k--4*X- - -lotD _ Zip Code: 'baq'51 _ Fax: 3;Lt-?I"_]-`,1
E i,Ylaii. i���' ? (a CIYIAAJ-COW � Phone No ?7a+-337- '���D -
icil[.ita fee simple Title Folder on next page if different E-Mall�U,1,f" . UC
from the Owner listed above) State or County License q airy
If Value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If vaIWe of HVAC is.$7,500 or more,a RECORDED Notice of Commencement is required.
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DES;,t,G'NER/ENGINEER: __Not Applicable MORTGAGE COMPANY: Not Applica�le
Name Name:
AddYeas: Address:
- --
city `` State: City: State!
zip:'L Phone —.--- Zip:._..- Phone:
FEF'SIMPLE TITLE: HOLDER: Not Applicable BONDING COMPANY: Not Applicabie
Name: Name:
Address. _ Address:
City, _ City:
Phone: Zip: Phone: .�
Ul1NER/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.LLXa (`l'',0,:0t'V¢rakes no representation that is granting a permit avid ac ihai ize the permit holder to build the subject structure
liici�:`ts in conflict with any applicable Nome Owners Association rules,bylaws or and covenants that may restrict or prohibit such
truct:i;te. Plr�as4 comult with your Home Owners Association and review your deed for any restrictions which may apply... :
n conWeration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
! n accO dance with the approved plans,.the Florida Building Codes and St. Lucie County Amendments.
Ize following building permit applications are exempt from undergoing a full concurrency review: room additions,
5trUf1,,ires, sWrnming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use`
`WAR'W'�NC; -ro OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
`T-vi trE Fop.traPROVEMENTS TO YOUR PROPERTY. A P40TIC-E OF COMMENCEMENT MUST BE RECORDED AND
POFTiED ON THE JOB SITE, BEFORE THE FIRST INSPECTIONS IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIYH "dl Uk' R LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
_ �-
Signa�ure of Owner/t.Qssee/Contractor as Agent for Owner Signature of Contractor) Icense Holder
i 5iiAif'.E OF STATL OF FLOR16�
VC
COW COUNTY OF
The irnin8 ii]Sti ,er t was,a �owierag efvre nee 1€',4 for ping ir�str ent wa« nowledg fore me
this day of I -0Z by this _day of zo by
Nami3'of person rnaking statement. Name of person making statement.
Perscnulliv Know _ _OR Produced Identification Personally Known OR Produced identification
'r e of identification
identsfirat. _� Yp' ' '
Produc
i
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(Slgnattlre of ary Pu lic-State of Florida ; g a ur of Nota ublic-Sta
t/1/ti I air"� otary Public State of lo' a
�aa� ) pmm.,Ian E4o. / � a 1, aXNey M Antonelli i
CDrtzr;;iiSSiGn 0.�� •p /��eal Notary public State of�Ip Ida
} Ashley M Antgnellio°� Expires 10I18/2'on02� 9 0" M -,
— -� �-� ----r Ui c�ph xpires 10/18/2021
REVIEWS FRONT VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE;
RECEIVED
DATE'.
COMPLE r E
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