HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED G
Date: Permit Number: 1 D d? '6�qTI j
RECEIVED
Building Permit Application FEB. 0 7 2016
Planning and Development Services Permitting Department
Building.and Code Regulation Division St.Lucie county
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PRQPOSEQ INP,ROVEMEiVT LOCAT,-', Y
6
Address: / / ��� �Q�/Y er Aotr C !k6'e'[r x:71' 3 Lfn/ aa
Legal Description: j;L/ 57
Property Tax ID#: f (7 b Z a �" Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRiP1`lON aF WORK.
�) 6,0
CON5TRllCTIONINFORMATIO(V mi
v
r
Additional work to 6e pertormed under this permit–check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ lop Utilities: —Sewer —Septic Building Height:
owNER/I. sEE coNTRACTOR.
_s
Name �^ Ld/�7�aJ Name: ( �%J^ Q !i
Address: (� c/ pgJr 4l Company:
City: f'°�-- State:%E(_ Address: S J l k.) 01
Zip Code: Fax: City: State:��
Phone No.(__ _'� Zip Code: _�9993 Fax:
E-Mail: Phone No r,17d .3 WZ
Fill in fee simple Title Holder on next page(if different E-Mail g /.
from the Owner listed above) State County License 4E�G .�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPRI.EIViENTAI CNSTRUCTlON LIEN LAW INFORMATIQN
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: . . Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEESIMPLE 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 recordin r Notice of Commencement.
Signature of Owner &E for as Agent for Owner Signature of Contractor/L older
STATE OF COUNTY OF ORIDA� STATE OF FL
4 1 �kLr COUNTY OF ORIDA �4 I U LA�
The for oing instr t was acknowledged fore me The for oing instrument was acknowledged efore me
this f day of rU 20 y this-day of —`✓-yUA� ' 20_by
(Name of pers knowledging) (Name of person ack w dging)
(Signature of Nc a ublic- tate of Florida ) (Signature of Notary P7nR
tate of Florida)
Personally Known 7R Produced Identification Personally Known Produced Identification
Type of Identification ._T,ype of Identification
Produced
JOSE FRESNILLO Produced JOSE FRESNILLO ,
o` { , J_�4� a ¢ e
} t o Notary Public-State of FloridaNotary Public-State of Flori a- , om fission # FF 184850
Commission No.� a (y �nlssion,�FF 184850 Commission No. � aQ; M�.
Expires Dec 22,20 8
oFF� My Comm.Expires Dec 22,2018 " r." oFF ,�
e o "` Bonded through National Notary As,n.
',filo� Bonded through National Notary Ass 1.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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