HomeMy WebLinkAboutMoynihan AppII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date
Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300.VirginiaAvenue, Fort Pierce FL34982 Residential Y
Pho e: (772) 462.1.553 Fax: (772) 462�-1578 Commercial
PERMIT TYPE. {�� y�
Additional work to be performed under this permit —check all that apply -
Mechanical — Gas Tank _ Gas Piping Shutters
Electric _ Plumbing _ _ Sprinklers _ Generator
S Ft. of First Floor:
Total.,Sq. F` of Cnnsrru:tion: q.
�r �j C -0 Utilities: Sewer _.. Septic
Cos�of Construction: $ � � --
gddress: 1 V LA,L- If'-
;z state: FL
Zip Code: Fax:
P k one No.=-.0g 3D
Ejvlai .
Fitt in fee simple Title Holder on next page (if different
from the owner listed above)
Windows/pool's
Roof pitch
Building Height:
Name:
Company-. 'A mac, -,[ t}roatri�t t.�AecfSfr ��
Address:l C3 a b0 b"'
-
City: J'1 Stater
Zip Code: 3 3 Fax:
Phone Flo-7'7'+4'f?0
E-Mail
state or County License Q C1 221-7
If 4ue of construction I. $25t30 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is 7,SOO or more, a RECORDED Notice of Commencement is required.
_ Not Applicable
Name
City;; ` State
Zip��:.__-----•-----.Phone .�....__...�.^
FEE }SIMPLE TITLE HOLDER: -T_ Not Applicable
Narpe:
Address:
Phone:
MORTGAGE COMPANY: _ Not Applfi fable
Name:
Address:
City: State -
Zip: _ Phone: -
BONDING COMPANY: Not Applicable
Name:
Address: _
City:
Zip: Phone:
aWNtR/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as.indicated.
I certiY`y that no work or installation has commenced prior to the issuance of a permit.
A. LUCJU: t:o4iity s-nakc.i no representation that: is granting a permit will auihorize the permit holder to build the subject structure
ruhich:`Fs n conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
Aructetre. Pir±as'R coilSult with your Home Owners Association and review your deed for any restrictions which may apply.;, ;
n cc,nsideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
n accgrdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
the following building permit applications are exempt from undergoing a full concurrency review. room additions,
ac ry structures, swrnrning pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use t
"AiFtOING TO OWNER: YOUR FAILURE TO RECORD A NOTICE. OF COMMENCEMENT MAY RESULT IN YOUR. PAYING
,Tyy.r�-E Fop 1111pRO VI MENTS TO YOUR PROPERTY. A NOTWE OF COMMENCEMENT MUST BE RECORDED AND
po$TED ON TIIE 30E3 SI'I'1 BEFORE THE FIRST INSPECTIons. IF YOU INTEND TO OBTAIN FINANCING, `,CONSULT
MTH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." _
re of Owner/ Lessee/Contractor as Agent for Owner
STATE Z)F FL01i6L;A
COUNTY
ar
The forgoing it;st urr,anc was acknow€ecage-d i;efore me
this t day of 20_ by
Name of person rnaking statement.
Perst:n� liy Knowr _ OR Produced Identification
lype.:''R Cent `NCatiCr,
Produce.d..._...._...._...... ._....._.._ ._.. ._...---- —._....
(Sigrioture of Notary Public- State of Florida ;
;l
Cor-nrnission No. ;Seal)
t`
Signature of Contract r/License Holder
STATE: OF FLORID
CilUNYY OF MA IoLalol_.
Vhe ,or wing instrument wa acknowled d before me'''
this ay of 2 by
Son A I,+VVI
�_�, Y-E
Name of person making statement.
Personaliy Known OR Produced Identification.''_ _
'i'ype of identification
Produced___
Siisnafure of_NWary Public- State of -Florida )
Commission No.e N 1� ibbc State of Florida
APi1Antonelii
My C0rnrniSSI031 GG'i 152970.
I
;�iREVIEWS
FRONT'
ZONING
SUPERVISOR
PLANS
I
VEGETATION
SEA TUR L
R V
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
DATI
COMP Lc-F t:f.1 J__-
. 2'/7./19