HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application APR 14 2017
Planning and Development Services PERIA1T1INC
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: y�n K) pa_g\� xt -1 I co,-4 rip"", P(-.
Legal Description:
Property Tax ID#: `1 C23' \ n I - (D I L) " 0001-I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�'1UY oil rJukl6�-_) Cerci bq C0c�e5
Zempv� anc� emplace I�►�c,'I�n L;c���-1-5,
CONSTRUCTION INFORMATION:
Additional work to be pe rmed under this permit-check all that appy:
_HVAC _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
--I or
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
OWNER LESSEE:- ,, .CONTRACTOR}:}. p
O 1 c
Name 9r1(`� �C C\` 1 1 Name: ff
Address:,i31 - ����CS(1C\ Cf ZAC'� 2\ R=. Company: 5-}' b��c.trif7
City: StateFj_X Address:('L�S-O IylQ
Zip Code: --� (4 GL_�) Fax: City.Snynon__,A1 State:!.
Phone No.,-J-�S 1 - Zip Code �m_ l Fax:
E-Mail: Phone Nodsw -
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: ,
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance 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,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
s
Signature of Owner/Lessee/Corftractor as Agent for Owner Signature of Contractor/License l4blder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 by this day of ,20 by
(Name of rson acknowledging) (Name perso cknowled ing)
I tr�"k e-1" itu31�- o,
(Signatu a of Notaq Public-Sta o Florida) (Signature of Not ry Public-St e f Florida)
Personally Known OR Produced Identification Personally Known V-----OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ommission No.T'- 18
MARVIN JAVIER NAVARRETE ,o�,avP�e���� MAR ER NAVARRETE
ZPaY PVI�4� ;2* o; Notary Public-State of Florida
Notary Public-State of Florid : * y
* IQA#FF 184524
Commission# 4U4
2018
Revised 07/15/2014 's;�q My Comm.Etlplres Dec 18,2018 •;?�� �,��;� My Comm.Expires Dec 18,
kOF pi11��� Bonded through Word NNotay Assn.
Bonded twou�tlitlOealNotaryAssn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS