HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
I APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Rafe_ Permit Number:
i
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2306 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4E2-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:�.:iG'�
Lot No.
s
..• i, / �.
Bloc
Block No.
Site 131(an Name: Y.�Uf.
Proi6ct Name:
9`
Additional work to be performed under this permit —check all that apply:
Mechanical Gas Tank _ Gas Piping Shutters Wlndows/Doors
Generator Roof P tch
Electric _ Plumbing T Sprinklers _
Tot4 Sq. Ft o� CnriSCru-tion: _
Cost of Construction: $ �
If
if
Sq. Ft. of First Floor:
Utilities: _Sewer Septic Building Height:
4d'dress: /' --
ci41:: --WX4y Stater&
Zi p Code: Fax:
PF 6ne No. ? „
Fillin fee simple Title Holder on next page ( if different
#ram the Owner listed above)
of construction is $2500 or more, a RECORDED Notice of Commencement is required.
of HVAC is. $7,5O£1 or more, a RECORDED Notice of Commencement is required.
Name:
Company: µi& JF xof�St 2(1 mga tk,A —"
Address: 110 6 DOW
City: Stater
Zip Code: 3aa bl _ Fax:
Phone info `7"7 a- 337- 41f70
E-Mail
State or County License l-
GNER/ENGINEER: _ Not Appl
e
Adore-ss:
-- - State
Phone.,,,,..,,...,...
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Ac�clres5: —._
City:'
Zip:". Phone:
MORTGAGE COMPANY: Not Applica
Name:
Address:
City: State:
Zip: —.—____. Phone: - -
BONDING COMPANY:
Narne:
Address;
City:
Zip:
Phone:
_Not Applicable
3WN;ER/ CONTRACTOR, AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as'ir>dicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
A. LUC(e c;ouiit:v s'r;aks s no rep esentation that is granting a permit will our hor'ize the permit holder to build the subject structure
olich'i ;n conflict witb any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
Vucture, Ploas� com-ult 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 ail respects, perform the work
n accprdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
"he fa'.lyowing building permit applications are exempt from undergoing a full concurrency review. room additions,
rccas;ti7r}! strurt,ure s, swarming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
rWAANI NG 'I"O OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
T'WICI" FOR 1IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
P(' 5TElD' ON THE J013 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
W I TH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.'
Signature of Owner/ Lessee/Contractor as Agent for Owner
S7,W E JF FILO&iL;
COUNTY OF V
The- 1int3 ir,st,'W' era s acktsow'ea efore me
this .r day of 2Zrby
Name of person making statement.
Per P".0ial'y Knowr. OR Produced Identification
I"ypei ident!ficatic.s�= ' --
Produc`ad
M
Pub4c- State of F
Signature of Contractor icense Holder
STA T i OF FLOR1
CGUNTY OFSbe�oJ.
1•h,o ro oling irlstru ent s acknowledg d efore me'
this- day of 24�by
Name of person making statement.
Personaliy Known OR Produced identification
's•ype of identification Produced.-
re ofPotary Pu
Carnrriissir;n iv"."a, (h� PTMAntoneW
State o€ Froridk Co mission
Ashley on C t s t�n� l
of
gr P4 a I�U#}lic State or Ffarida
}, 1cr,ley M Antaneiri
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