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HomeMy WebLinkAboutGagnon AppINFO MUST 8E COMPLETED FOR APPLICATIOM TO BiE ACCEPTED 1. - it �, �:,�kl�T"�`` �` F t r� Fs. i ri .?k �.� „^ Planning and Development Servfces 8uilclr'rrg and Code Regu{atron Division z30� Virginia Avenue, fort Pierce FL 3�982 Pho�le: (772) �6���s553 Fax: {772) 462-1578 PE�t'M�T TYPE; '��� �_ Permit Number: Building Permit Application Commercial Residential Addr�'ss: �,� 1 �. Property Tax in #: 4 — �s O� r �, �. Lot No.�:,�� Block No. �� Site Plan Name: _,_.� project Name: Additional work to be performed under this permit —check all that apply: ,,Mechanical � Gas Tank _Gas Piping ,� Shutters �'t Electric � Plumbing _Sprinklers _Generator Tnt�'1 5q, l"'•: aF Cc�r'�si:rfa:'t'san: _�._._ Cos�''of Construction: $ �� Sq. Ft. of First Floor: �.,�,�,,. Utilities: Sewer � Septic VVQfindaws/Danis Rnof PEtch Building Height: Narrle: � Company;�,ItA F�r_r1"Ct aG Px¢Uare�l � �� Address: i+ [3 ' A. � bf� b�' City: �l State:_ zip code: 3ag3"� _ __ Fax: 3a�-777�`-�a� Phone Na �?7a,W337-''-��'�'?� E-Mail �'�..IA.r�S � r -� .. State or County License #� f�__��..�.— If value a¢ cae�strucxion is $3500 or mare, a RECORI]ED Notice of Commencement is.required. If va+ue a�F �9VAe is� 57,SD0 or mare, d RlWCOR(3ED Notice Df Commencement is required. Yi li, iL N State: �/ Zip Code: � 1�.J�.�...�.-_ Fax: '_� `� PFiane No.��_„ -- 1"-P;naii. �---� Fill in fee simple Title Holder an next page { if different Pram the Owner lister! abo�ej '}, GI�lEER: Not App Narr�e Addi'e'�s: City;;" StatE=: Zip:`��_..�..._:--�---Phone --- FEF�IMF'!.� Tl�it.F Fi�}Ln�R: _--. Not Applicable Name: Ac�cl'r�ss: --_m GitY:s,�.�...._. ZI�):`:'� Phone: MORTGAGE COMPANY: ,� Not Applica�aie NamE=: _ Address: __ City: State: Zip: �,. Phone: BONI�iNG CfJMPANY: _Nat Applical7le Name: Address; City: Zlp: PhonE iNl�,ER% C�NTRACa4?R AFFIQVtT: Application is herE>by made to obtain a permit to do the work and installation as ir��dicated. :ert�y that no work or installation has commenced prior to the issuance of a pE>rmit. �uci; t,a4[!L'u trrdkr..s na : ep: esentatidn ti�at is granting a permit vvill auihoi ize the permit holder to build the subject structure rich+is ;n conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such u+'ti:[re. PiFas�� consult vw�ith your Home Owners Association and review your deed for any restrictions whrch may apply.,, . cc�nsitleratiors of the granting of this requested permit,l do hereby agree that I will, in all respects, perform the work accnt"dance with the approved plans, the Florida Building Codes and 5t. Lucie County Amendments. e fallowing i�uilding permit applications are exempt from undergoing a full concurrency review: room additions, cis=,c�rar struci.!.+res, sw'.['nrning pools, fences, walls, signs, screen roams and accessory uses to another non-residential use qA!���@y� T� �'Wl1�EiR: '!"Di!€lit �AILl3I�lE �'D REC©RD A iY©tICE OAF' CDII+IiMENCf:MENT MAY RESULT iN YDUR. f'Al'1114G '�' , 1 �E FCAIF� ��iiP'R(3'TIE.141E411TS TEI� N(DUR PROPERTX. A �IDT�S:E (DF COMMENCEMENT MUST IBE I�EC.AiRD1=D Al1iD ?�+�b�TED tDl�9 TaIE .IQS SITC B€FS?fiR'E TIE FIRST IRISI9EC�101'+C. lIF Y®U 1111TEND TO OBTAINI FIIVANC1iNGy C�AANSIiiT i�UdA"[i 9f �li9F il.E�§i1,iE.C� 1'�R Aill ATl"6if�11i1:Y E3E�©RE R€C[1R1D�lIIG YC1il1R Y+dOTICE OF COMMENCEMENT."' .. -_, Signature of Owner/ Lessee/Contractor as Agent far Owner �, The ��r�oin� it��st,�carr�ar�c was acRr!rrvseoged iiefure nae this r,. day df _ , 20_ by Name.af person rralcing statement. Perct7!7e[I�y Knnwr�� ..- ._..,._�,-_ OR Produced Identification 'iYpr�;`r��r�[dent�ficatir�� �!� i ��� ,;, . (5igri�ture df Notary Pubii,:- State of Florida ) COn'�CYliSSIOn i`4. _..,„,.."...-.. __� lSE!all ;' . REI�1��,EWS FRUNT' ZDNINC Ct�IiNTER REVIEW E� �---�� Signature of Contractor icense Hoiden a�'ATl: OI� FAO A -� -� pp CQ:Jk',1�`Y �F_�',,, 'r't'J11Gta'C�` _. 1'i��e €d��in yli�str a was ac�knowiedg� kbefore me tftEs � da of 20 by Name of person making statement. >;ersonally Known � ClR Produced Identification. rype Uf it;ent+fication _ Produced._-..-- _ � Pu Commission SUAERVISOR j PLANS VEGETATI REVIEW I REVIEW REVIEW of FloridaSS) �� }} Nota Public` State F ori� .� Ashley M Antonelli,.' � �a� i`•�xp es 0! 8I202'f ' EV� REVIEW .; �: