HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: a'� `y 1 Permit Number:
Un
EIVED
14 2019
Building Permit ApplicatiPlanning and Development Services hn , PPrmi�ing
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED INPROVEMENT LOCATION:,
Address: kLM� ra a
Property Tax lD#: �' Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
c G A-n C45'0 IJ,,
iv � r
CONSTRUCTION:"INFORMATION:
Addit' nal work to be performed under this permit—check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
amu.
Cost of Construction:$ 06 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name `/bJ C IZName:
Address: ,TID Z c Company: M&V-119
City: IL7_ l c�iIL6&_�; State: Address:_2,3 V V _50 - /Yl//NTII l t1,�✓t
Zip Code: 3VZ Fax: City: �_p 4 r' State:
Phone No. Z /�'��o, Zip Code: .5 L1 9 S3 Fax:
E-Mail: Phone No -7-73- 36/- -2-5-SZ
Fill in fee simple Title Holder on next page(if different E-Mail CO/y
from the Owner listed above) State or County License .67-• �l/L'/C CV dw�Y
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEIVIENTA
Lt NSTRUCTION LIEN LAW"INFORMATION
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:
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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Si to e o Owner/Lessee n ractor as Agent for Owner Signature of ontra r/License Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF .5 i` o U C/c= COUNTY OF 57- • X UG/ Z_�_
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
tt JLday of 'r 207 by this,,;2Lday of ��fji1/rJ/� & ,20,L�L by
I& )_P y/ n
Name of person maki g statem t. Name of person making statement.
Personally Known�OR Produced Identification Personally Knowny OR Produced Identification
Type of Identification Type of Identification
Produced Produced
SA E GONZALEZ
(Signa re of NBf PISA& n ure o b ic- @hFJ%id? 2019
• :• ':� SA R GONZALEZ •,°�:,,,.
Co mission ••= Y C ISSION($"}45989 Co mission (407)398 053 FbridalloteryServka.com
EXPIRES July 01,2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
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