HomeMy WebLinkAboutBuilding Permit AppINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
and DevefopmentServices
and Code Regulotion Division
ginia Avenue, Fort pierce FL 34982
(772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: F�tot�k .f
Permit Number:
Building Permit Application
Commercial Residential
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Propear..ty Tax ID l
Site P!'an Name:
Pro)ett Name:
under this permit - check all that apply:
Additional work to be performed
Gas Tanlc Gas Piping Shutters
;:.Mechanical _
Electric Plumbing Sprinklers Generator
Sq. Ft. of First Floor:
Total}iSq. Ft o� Consi:rUk tiorn�:
Cost,of Construction: utilities: Sewer Septic
Na(ne ' w
Address: �
Cit&r: _k 1'k f .- Stater
Zip Code: LL-}._q-q.. Fax:
Phone No.1`�� 05_
c-i'Jlaii.
Filfiin fee simple Title Haider on next page ( if different
�frann the Owner listed above)
w— —n is �2500 or more, a RECORDED [notice of
f t
LUL IVU.
Block No-
140 Windows/Doors.
Roof F;tch
Building Height:
Name:
Company:MtA F�'1 paf. P�' xr 1�2� PD "
Address: w C3 T ahr�Gt k- flir" -
City: C state:
?L
Zip Code: '3b - Fax: lit -
Phone No
E-Mail LIAM
State or County License
Commencement is required.
if value of conatruc so
If value of RVAC is, $7,500 or more, a RECORDED Notice of Commencement is required.
sR
F•
T.
EE{R: _ Not Applica
Adcress:
aw"'i _ State:
Zip:_ .... _ Phone
FEE 55IMPLE TITLE HOLDER: Not Applicable
Name: _�...
Addy e�5:
city
Zip: Phone:
11
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: Stater -
Zip: _ .� Phone: -
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
____Not Applicable
WN;ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 ce 4i that no work or installation has commenced prior to the issuance of a permit.
t. s U6� ._� i,ouilty rr.akc-; n0 representation that is granting a permit will aui horize the permit holder to build the subject structure
hich jr in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
tructtiire Pleas � 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 acccil ance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
he following building permit applications are exempt from undergoing a full concurrency review: room additions,
cc, ssrorr structures, sWinrning pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
'WAR "NING -1O OWNER. YOUR (FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TIt FZ'E FOR IMPROVEMENTS T4? YOUR PROPERTY. A NOTWE OF COMMENCEMENT MUST BE RECORDED AND
I'"05-rED iDN TIIE JOB SITE BEFORETHE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, C�ANSULT
'W�, TH YOUR LENDER OR AN ATTORNEY_ BEFORE RECORiDIiNG YOUR NOTICE OF COMMENCEMENT." q�
a.xi�ca
Si na't V re of Owner/ Lessee/Contractor as Agent for Owner
g .
The F'� going irstrtirr+ e was act' wi,rngtd oefure me
this �ay of 26 by
_ i i
of person making statement.
pPrr.,&haliy Known _ OR Produced ldentification
i ype,,f3,�L went!ficatior,
J 1AA 41
re of NoWZ Publf-- State of Florida
Corr nnission No. N94
°ve ' Notate public State of FOrida I
Ashley M Antonelti f
Aqux
Signs ure of Contractor icense Holder
STATE: OF FLORI
COUNTY OF_V3IaAd_
i Eli ro oing illstru nr was ack wledged before me
this ay of 20 by
Warne of person ma sing statement.
Personaliy Known _ , OR Produced Identification( -
i'ype of identification
Pro -ed
—14
Signature of tart' ublic- State of Florida )
mmission i0. Y° Aver � +y Public°State of Fk
Ashley M Antoneili
H MV Commission GG 152;
011812021
—
'�'aFcs° �xpres
101181202i
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DATE':`
DATE:7
2/7./7.9