HomeMy WebLinkAboutBuildilng Permit Applicaiton ALL APPLICABLE INFO[Mg BE C PLETED FOR APPLICATION TO BE ACCEPTED -2 ,
Date:LECAA÷LUt t..) Permit Number:
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ta308110601.1.0 ,
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce ri.3402
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential \/
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow et the end of line i
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Address: •Id _____
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Legal Description: _ - A.
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Property Tax ID#: A I 2 0_ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: _
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CONSTRUCTION INFORMATION:
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di°'• war t 6 .ePC‘ , orme. unseron. t is permit-c cc a aa pp y:
II HVAC Li Gas Tank —has Piping '_Shutters - Ll Windows/Doors
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0 Electric —Plumbing Sprinklers E ___Generator Roof 1, Roof pitch
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Total Sq.Ft of Construction:_ S .Ft.of First Floor:
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5C-0
Cost of Construction:$ Utilities: Sewer Septic Building Height:
bWkEdiutitc v .",‘,..,--'-',CONTRACTOR'
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Narne _
iffird56111111t All: r „,f, I Name: t=ra-tiCif, L- • i
Address: i .. i 0, .L." i . . _J-Vt V mpany: , -, , illi._.-1111 _ : ...-- i IP' .•''' Aif"x.
City.„ 'Aill ..: p..1- -a_ A .State —- Address:
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Zip Code: _00 Fax: 0 . i Cit : '11167411FAINFIN__ tate:* t
Phne oNo. 4 ire , Zip Code:Aio 0 , , i . - Fag:40, F ' A 1 A
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i Phone No._ _ .. _Li"
E-Mail: . ma 2 irr-OASS, lic-,--)14.1-ii4...r I
Fill in fee simple Tide Holder on next page(if different E-Mail: eiteri„. .,. ,
from the Owner listed above) State ounty License. „ 121111
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It value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SURPLEME ITA CONSTRUCTION L1PNULAW INFORMATION `F -1 K ° _,, ,.
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: .
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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 far 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,die Florida Building Codes and St.bide 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
WARNINGTO 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.postied on the jobsite
before the first inspection. If you intend,t^ obtain financing, consult with lender or an attorney before
commencing wor o�recording yo r •'Ic- of Commencement. *_� _
l__ ��irhr.it `� 1 °ter' L
Signature of Owner/Les /Co/racer as Agent for Owner Signature of Contractor/Li nt Holder
STATE OF FLORIDA L� rr. OF h 6 STATE OF FLORIDA
COUNTY OF Y. COUNTY OF Iv_ i _�._
The fing Inst 1+;:.2si. a -dg efore me Thecif-going ins, .,1:t w.. . f r edgy�, fore me
this da of . L iil Zo. y this -day of r _ WC 1 RIM ,2U kW+Y
40 "a. s if E
Name of pens akingatement ame-or person aking tatement
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Personally Known_ OR Produced Identification Personally Known • OR Produced Identification . _,,,
Type of Identification Type of Identification
ProducedProduced
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I ri.:. tore of Nota Public-State.• Florida) (Signature of Notary Public-State of F o )
Sr tCommission No.F - l ('kt") Commission NF.Fe- ?:q (Sea )
_ r _ .. ,. E CRUZADO ti+:�"i.f CRYSTAL MARIE CRUZADO
ram,. MMI`3 M#FF993217 } `= MY COMMISSION#FF993217
REVIEAIS 4Fnu ONt G,020 S PERVISOR PLANS •z z TIONS 1 4�F, �02�IANGROVE
`;•tOUttES 7 IEV+1 EVREW REVIEW t o{ ��: ;, REV1EW
DATE taatT��.,-: •-f+o,=..,
RECEIVED _ _ .____
DATE '
COMPLETED I _ --.-
Rev.8/2/17
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