HomeMy WebLinkAboutBUILDING PERMIT APPLICATION:I APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date.!
ti,..d"a...E.A
Plans ng and Development Services
Building and Cade Regulation Division
2306 Virginia Avenue, Fart Pierce Fl. 34982
PhAe: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Building Permit Application
Commercial Residential
Property Tax M #: I4 o2 " % 1M
Pfan Name:
Mechanical _ Gas Tank _ Gas Piping Shutters
Electric Plumbing Sprinklers _ Generator
T Sq. Ft. of First Floor:
TotQI:;;Sq. F` c�4 Cnris�ru:#ion:
Cost'of Construction: Utilities: ^ Sewer Septic
Name
Ot . State
zip Code:
Phone No.?d--L
Fill"in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No.
Block No.
W inuaww vuv1 a
Hoof Pitch
Building Height:
Name:
Company:MIA
"
Address:I 5 D
city: t 1A.. I-I>-1xb�. G - State;
Zip Code: 3aga Fax:
Phone No -7"7
E-Mail�'}.uT_�s
State or County License 1
If vatbe of construction ',, $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.
s
DEW GNER/ENG VEER:
— Not Applicable
MORTGAGE COMPANY: Not Applicable
Nar�e°._
__. ---- ...._ _
!Name:
Adcfr6ss:
Address:
city;
State:
City: State:i_
Zip;;, _...._..__, Phone
4-
Zip:._..____ Phone:
FEE ;SIMPLE TITLE FOLDER: _--
Not Applicable
BONDING COMPANY: Not Applicable
Warne:
Name:
_
Accl`'ess:
Address: -
Cityt
f ity:
- Phone:
Zip: Phone:
:)WNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the worse and installation as.iridicated.
I cert4 -that no work or installation has commenced prior to the issuance of a permit.
A. LuC`k' COIJ sty srra!ee•5 na rep: esentatior, that is granting a permit wiil auihorize the permit holder to build the subject structure
nrhich:i in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
arurture Plnas� cansult 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 accci,i'dance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
the fol'16wing building permit applications are exempt from undergoing a full concurrency review: room additions,
access ors, Strurt!.trE`S, sw'.mrning pools, fences, walls, signs, screen rooms and accessory uses to another non-residentia3 use
:'WA i,NG TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR. LAYING
'T"TI-C-F FOR It�io-�'i2OVEMENT5 TO YOUR PROPERTY, A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
eg!orI II. ON THE jos SITE BEFORE THE FIRST IN5PECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
xn: ti-e.. e�fnc:.aif a MaUd con Y'i&D AAA jL-"npw(iwr RrpnRE RECO R� ymiir:lraUR NOTICE OF COMMENCEMENT:'
nxnco as Wm -------
i,
-- - - -
,.
Sign4fure of owner/ Lessee/Contractor as Agent for Owner
Signature of Contract6r7Llcense Holder
Si"i T,E �F IF'L(,'&i,I;:A
STATL OF FLO A
�
CCU . NIT Y 0 s --------._ ._ _ _-----.�__ _
COUNTY 0 F -
The i r oink it stnarr,arit was acknowic- aged before me
by
1 i1a r 1•poing mstru em was acknowledged before me
this day of 20� by
this day of _ zd�
Name of person rnaking statement.
Name of person making statement.
x ;
Perczd; iA;v Knn. wr OR Produced Identification
personally Known OR Produced identification
Iype i icientdicatir-k --
Type of identification
.ar.
Prodq% ed........ � . - _._..—._.._..
Produced_-,.._..
tJ
anature
(S;grtture of Notary Public- State of Florida ;
of N9 ry Public- State of F orida )
Commission No. (Seal)
Commis!Jcin No. a
A� 1Val8ry Public State of Florida
?�i
Aafsley M Antonelli
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---- .. ,• P We
r
I
a �d� Expires 101
812621
REV FI WS
FRONT'
ZONING
SUPERVISOR
PLANS
VEGETATIO
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE;'
f"F,, 11tEf3
_
DATE,-_
2/7./ 1.9