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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO HE ACCEPTED
I
a;. Permit Number,
� , N
Pla `ping and Development Services
eui, .. ing and Code Regulation Division
23gg Virginia Avenue, Fort Pierce FL 34982
PhOe: (772) 462-1553, Fax: (772) 462-1578
i
PE,�MIT TYPE. � JbKq
Address'
Site
Building Permit Application
Commercial Residential �/'
rty -Fax ID #: � �__ 1 �!' � =' �� � Lot No. r-J-7-
Ian Name: �.11 JITIYI�L UI4Y, ! '2-- — Block Na.�'
-t Name:
Adt}`f'tional work to be performed under this permit -check all that apply:
<' Mechanical _ Gas Tanis _ Gas Piping Shutters
Electric J Plumbing � Sprinklers _ Generator
Toth! Sq. F` of ConWLA::tion: _w �3�. ^_ Sq. Ft. of First. Floor:
Cos , of Construction: $ �' , �� •_( ]) Utilities: —Sewer _Septic
Wine`
_ U State:t #�
Code: _96, tax:
-ne No, -76)
in fee simple Title Bolder on. next page if different
n the Owner listed above)
Y-W indows/Doors
Roof Pitch
Building Height:
Name:
Company:.juf� ' MSG 1 eUtcrdl tk �eifS�ctv_( u
Address; 110 13 Totha.kQ kl ©0 Ue I^
City: �(ka+_ i",e- —Stater
Zip Code: 3MV7 fax: 3ai-3�v_
Phone No -77'a1--3 7-
E-Mail9L#Ar
State or County License f'
If v4fue of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is. �7,54o or more, a RECORDED Notice of Commencement is required.
I
ress:
Not Applicable
State:
ZiPV—__...-..__. --- Phone ...--�.
FFF SIMPLE TITLE HOLDER: . Not Applicable
Address,
cjty:
Zip.;` Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip:.--,--_— Phone:
Not Applicable
State:
BONDING COMPANY: _Not Applicable
Name:
Address;
City:
Zip: Phone:.
V!fl ER/ CONTRACTOR, AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or Installation has commenced prior to the issuance of a permit.
A. vnakes no representation that is granting a permit will aulhori?e the permit holder to build the subject structure
1hich is in conflict with any applicabie Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
truc: vre. PiFas� cons ult w. th your Home Owners Association and review your deed for any restrictions which may apply.
n cchsideration of the granting of this requested permit, I do hereby agree that I will, in ali respects, perform the work
n acOrdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
he fgllawing building permit applications are exempt from undergoing a full concurrency review: room additions, E .
structuren, sw'.rnming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
`WAANItNG TO OWNER: YOUR FAILURE TO RECORD A NOTICE Of COMMENCEMENT MAY RESULT IN YOUR PAYING
'�W.p--E FOR SMPROVEMENTS TO YOUR PROPERTY. A NOTISE OF COMMENCEMENT MUST BE RECORDED AND
P015I ED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
4Vt i YOUR iLENOER OR AN Afil'ORNiEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Iri
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE C F Ft.CDML;A
CC,4J1 'CITY GV - ..._....-------- ---- ---
Th' ;`�fargoin was acRriowieojged ; &Ore me
this; day of_ , 20_ by
person rnaking statement.
Per, �n8;v Known OR Produced Mentif€cation
type' ot„idenrflcatic,
(Sig idturrel of Notary Pulbilc= State of Florida )
co", rnission No. (Seal)
Siena ure of ContractorJLi ease Holder
STATLCOUNTY
(�F FLC3MA�
�1�IaIdaYOF
rile 1nr ing instrument was acknowledged before me
this day of}pfkG,t!�j2o2ir by
Name of person making statement.
Personally Known. �� OR Produced identification -
r'ype of identification
P;t}luced__„—. -
re of(NAtary Public -State of Florida )
Commission No�4
(SUNkEYK NdTONEW
MY COMMISSION # HH 14361
..N-....,..._-.�...._�»--....�.w.�—.�^
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