HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: January 2018 Permit Number:Ms
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Building Permit Application JAN 11 2018
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential XX
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 404 N. 38th St Fort Pierce
Legal Description: WESTWOOD BLK 1 LOTS 13 AND 14(0.32 AC)(OR 4068-2220)
Property Tax ID#: 2408-601-0012-000-0 Lot No.13/14
Site Plan Name: Block No. 1
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF:WORK. r
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CONSTRUCTION INFORMATION
Additional work toe performed under this permit—check a appy:
HVAC 13 Gas Tank []Gas Piping a_Shutters Windows/Doors
tJ Electric 1:1 Plumbing Sprinklers El Generator Roof Roof pitch
Total Sq.Ft of Construction: /``` S Ft.of First Floor:
Cost of Construction:$ 2- Y�i- Utilities:ll Sewer F]Septic Building Height:
OWNER/LESSEE: .'CONTRACTOR:
Name,lose Alonso Vides Sierra Name: � R. 4• ' zeldr
Address:383 SW North Shore Blvd Company:
City: Port St Lucie State:FL Address:_1�� S� LibkJrry
Zip Code:34986 Fax;None City: SA ZCrC}e State:,F�
Phone No.772 812 5066 Zip Code: - Yy83 Fax: ? 2-GY8 6-4Xe,
E-Mail:josbconcreteperfection@hotmaii.com Phone No. '77.7- / -M
Fill in fee simple Title Holder on next page(if different E-Mail: e
from the Owner listed above) State or County License: CGGI'.So?g/l
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL ON TRUCTtON�L{EN'�l%1W INF�}RMATION Z ' �' "
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:None Name:None
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:
OWNER/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.
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.
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Signature of Ow4eff LesseeXontractor as Agent for Owner Signature of Contracto—r/LicenM Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF . Luce COUNTY OF 54. ZuciP `
The forgoing instrument was acknowledged before me The fo ing instrum nt was acknowledged before me
this-K day of 7Cs�_ ,2oA by this day of aw4ri 2oby
r%edlN Q. /vl A(( �i°!/!.(/ R. 'a""
Name ofersofmakinfi tement Name of persomaking stdiVme
Personally Knowi ✓ OR Prod u Identification Personally Known tl OR Produce Id tion
Type of Identification Type of Identification
Produ Produced
(S- nature of Notary Pu f o ' E L
o err State of Florida-No')I
r ublic
�+'�ue��,; t of Florida-No y 4811d6pre of Notary Pub rc-Stat � )
Commission#FF 93 1 8 Commission#FF 78
Commission No. ,' 400mm.Expires 01.30 Coo
Bonded Through fission No. ', Expires 0 - -2020
.� ra����°:� "Comm.r, Bonded Thioug
111111% Notary Notary Public Underwrites Notery Public Under ri rs
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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