HomeMy WebLinkAboutBUILDING PERMIT All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Y/ Permit Number:
III, i�
Building Permit Application
Planning and Development Services
Building and Code Regulation Division -�•�
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: L
Address: �i7i (f-
Legal Description: 15'
Property Tax ID#:-r to f -- Lot No.
Site Plan Name: \ lrA Block No.
Project Name: bGP�I f=
Setbacks Front Back: Right Side: Left Side:
fi.. .4
wil
i Iona Wor o e pe rme under this permit—c ec all thatapply:
_Mechanical _Gas Tank _Gas Piping _Shutters -Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof l it1
Total Sq. Ft of Construction:_1260 Sq. Ft. of First Floor: -L
Cost of Construction: $ S116" 1 eVe Utilities: —Sewer —Septic Building Height: 1 f�
r
y`
Name _ Name:
Address:Z 7 Company:
City: _State. Addre y---
ZipCode;3 C(2)2i Fax: City: State: l C
Phone NoTJZ Zip Code: —
E-Mail: Phone N 7T
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County, icense
ff value of construction is 2500 or more,a RECORDED Notice of Commencement is requir .
Tv
DESIGNER/ENGINEER: of Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: _ of 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
commencin work or recordingour Notice of Commencemen .
I �J�� �-
Sign re o Owner/Lessee/Agent Signature of Contractor/License Holder
COATE OF UNTYOFORID��1 U4eJ STATE OF COUNTY OF LULLj��
The forgoing instrument was acknowledgeci before me The for oing instru ent was acknowledged-before me
this�?...d``ay of 20 by this P ay of 20jby
LA I) , c �se�� lLit, t� �-c�
(Name of perso cknowledging) (Name of person cknowledging)
JSiknature akVotary Public-State of Florida ) (Signatur of Publi to of Florida)
Personally Known OR Produced-=Stateof
Personally Known OR Produced Ide lfi f n
Type of Identification Type of Identification JAIME ORTIZ
Produced :�� Notary lorida Produced lic-State of Florida
,�•rc�'My am2018 / ` " ,Eomm.Expires Jun 1,2018
Commission Nl . �� •`> gpb�Ty Assn.485 Commission No. 'd V. �, '] Gommi FF 111485
I{ Bonded Tlvppn National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT — SAINT LUCIE COUNTY
FILE # 4388804 OR BOOK 4085 PAGE 678 , Recorded 01/09/2018 01 : 45 : 43 PM
NOTICE OF COMMENCEMENT
Permit No. Property Tax ID No.
State of Florida,County of St.Lucie
The Undersigned hereby gives notice that improvement will be made to certain real property,and in accordance with
Chapter 713,Florida Statutes,the following Informations Is provided In this Notice of Commencement. JJ /n����— r
Legal Description of property and address if available ZZ7 � , /r&CJ tL-c3yr.z Z..'
General descri tins of improvemeats
Ownerdessee
Address
Interestin property: 4 �,
Fee Simple Title holder(if other than owner) n 1T
Address
Contractor Phone#
Address M1M1 az# �L•' 3�'�—>�.�1,�L�
Surety Phone#
Address Fax#
Amount of Bond
Lender 1 V Phone#
Address I Fax#
Persons within the State of Florida desig�na�tw-7I�by Owner upon whom notices or other documents may be served as provided
by Section 713.13(a)7.,Florida Statu
Name ���, "``����"' ���'1 Phone# I
Address Fax#
In addition to himself,owner designates of
Phone# Fax#
to receive a copy of the Lleaor's Notice as provided in Section 713.13(1)(b),Florida Statutes. Expiration date of notice of
commencement is one year from the date of recording unless a different date Is specified. WARNING TO OWNER:
ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER
PAYMENT'S UNDER CH.713 13,F.S.,AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE TDE FIRST INSPECTION. T YOU INTEND TO OBTAIN
FINANCING, CONSULT V WrM YOUR�LFN�DFR OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF 7J1,
COMMENCMENT. uPry y �
-5 /�:4 $0jait
{tc gow r—f (-J �, / i
OwaerlLneee,or Owner's u Lmsee i Authorlred Omcer/Dlrutor?artaerMaasgsr/Slganmrc
i
Signatory s Ti le/Omce
Stale of Florida,County of
Acknowledged before me this ' day o 30 2—,by
ho is personally known to me or who has produce fty, SLAba.tt Ze.� as identification.
Signature of Notary Type or rint Name of Notary ' •
STATE OF FLORIDA LAR88N
ST. LU pppr�pr���S11phrvNum6 �' My COMMISSION#FFBB#a73
Tide:Notary Public THIS IS�V C.tRTIFY THATY '•,9!,,,• EXPIRES June 05,70P0
TRUE AND CORRECT COPY Of THE sp1139Ba11 F°^eMOu asnam
ORIGINAL .
JOSEPH E. SMJIH, CLERK
Deputy CleQFkk