HomeMy WebLinkAboutSanguedolce permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��� Permit Number:
1111040111JOI-0
Building Permit Application
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 1�
PERMIT APPLICATION FOR:
Pg. Ci4TION:
Address:
Legal Description:
Property Tax ID#: 3�7i 6"� 'lK.r/ �� Lot No.3�rf�1(t
Site Plan Name: Block Ne/�� _
Project Name:
Setbacks Front Back: Right Side: Left Side:
DESCRIPTION OF WORK:
„CONSTRUCTION INFORMATIONmilk
AaaitionalworKtoDepertormea uncier tris permit—c ec all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof lin 7iP Itch
Total Sq. Ft of Construction: p Sq. Ft.of First Floor:
Cost of Construction:$ IID Ga ,/lam Utilities: -Sewer _Septic Building Height:16
CTOR:
Name C, Name: Wit"Lpp,
Address: L4l Company: l
City: State: _ Addre :
Zip Code:�4ypz, Fax: City: State:
Phone No. 777,— 4 a— 16�4 75— Zip Code: Z Fax7y9�i -6%
E-Mail: Phone No772r
Fill in fee simple Title Holder on next page( if different E-Mail • 0.
from the Owner listed above) State or Cou ty License �OS7
If value of construction is 2500 or more,a RECORDED Notice of Commencement Is r6quired.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: e)cNot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER. Not Applicable BONDING COMPANY: ('C—Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFF►DVIT: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 ano Eovenants 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
Comm ncinn/ work�or recordingour Notice of Commencement.
!/t/L�
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID J COUNTY ppORID/��
COUNTY OF ��l .�i� (�l7
The forgoing instr ment was acknowledg before me The for Ding instryr��nt was a :knowle fte before me
this1 day of 20W by this' f day of Wig 2o[�by
W Q.4AIU'—CJI� l hAu ). r-,"r-O
Name of R&on making statement. Name of personng statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signaturftf Notary Publ < an a JAIME ORTf1 i nature o otary Pu li of FloridalJAIME ORrri
i� - ''•� -' '�' ►wry 1111C-$190 of Fmriaa
Notafr I" State of Florid
Commission No. t iEft4n.Emilm Jun 1 201, ommission No ` ' ON Jun t. 2018
Co IOn I FF 111485
ConxnlNba A FF 111495 &,Am lk "NMbf41NOVAM
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE. _ MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW, REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.8/2/17