HomeMy WebLinkAboutUtz AppINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Plonr'tng and Development Services
Bulldlhg and Code Regulation Division
2300 Virginia Avenue, fort Pierce FL 34982
phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
Commercial - Residential --,�
PERMITTYPE: T3u.c,lLNVr �ar&Pjp- -
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Site
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Additional work to be performed under this permit — check all that apply:
x;Mechanical Gas Tank Gas Piping Shutters
Electric _ Plumbing Sprinklers Generator
TotGi Sq. Ft of Consi rWtion:�--l—_T 5q. I i. of First Floor:
Cost'of Construction: $ �� go2.��� — Utilities: —Sewer _Septic
Na(Yie_. WVC w X-=
Address:I`G apt
Civi: State:
2i a Code: Fax:
Phone No. 93-.o�141 r1
Fill ire fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No.
Windows/Boors
Roof Pitch
Building Height:
Name: !
company: G
Address: ho 13 OLfit'` Dom'
City: -kaf K State;
Zip Code: 33L9'vi Fax: 3 1-2-42 _
Phone Na -7'7a-
E-Mail �I '�.v�i at�'CtAui rrnC.f{�
State or County License ?�t?
if vague of construajon is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is. $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
g.Narrre!� Name:
Address: Address:
State: City: State.:
Zip F_��...-.. - --- Phone � _—. Zip: Phone:
FEE'�IMPLE TITLE HOLDER- Not Applicable BONDING COMPANY: Not Applicable
Nare: Name:
Address: Address;
Cityt�'_._.____. City:
Zip; _T Phone: zip: Phone: -�
W11tER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certiiry -that no work or installation has commenced prior to the issuance of a permit.
t. LUC(e cout;ty rrrakc-s no . eptesentation that is granting a permit will auiho, ize the permit holder to build the subject structure
hich Is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohlbit such
tru(:t6re Pleas-:! consult with your Home Owners Association and review your deed for any restrictions which may apply.
n con 'ideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
n accei ance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
he foiloWing building permit applications are exempt from undergoing a full concurrency review: room additions,
ccas„ Vry struct urE s, sw`rnrning pools, fences, wails, signs, screen rooms and accessory uses to another non-residential use
6WA4141ING -1'0 OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR LAYING
TWICE FOR EMPRiI VEMIENTS TO YOUR PROPERTY, A P40T'ICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE .SOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, ;CONSULT
WITH YOUR LEiA)ER OR AN ATTORNEY BEFORE RECORDING VOUR NOTICE OF COMMENCEMENT."
signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Molder
SiATl E JF FLOhsL;A
COON ITY OF,- --_--
The fpr�oing instrument was acknowledged uefure me
this 'l`_ day of_ , 20_ by
person rnaking statement.
Per5dia l y Knovvr- OR Produced Identification
tY�3r Iq�4,tdent'ficatio-=
(Sign ture of Notary
Cornr6ission No.
c- State of Florida )
(Sealy
STATE.' OF FLO
CGUNFY OF !�
l -le i r omg iffstru em was acknowledged before me
this T_ day of 20'71 by
Name of person making statement.
Personally Known OR Produced Identification
Type of dentificatiorf •
ProduaLqc-e of A r
r..ed
J'A 't /42
t.
(Signature of tart' Publi& State of Florida j
Commission No. � '" a
t ♦ Notary ublic tate of Fiaricia
a� w Ashley M Antoneili
y ^W1W
2621
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATICOUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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DATE'.
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