HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `�' 9. 1 �% Permit Number:
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 )C Residential
PERMITTYPE: �I,"j.eC�G '�-� A _-
PROPOSED IMPROVEMENT LOCATION:.
Address: c� 6 50, Qcea-,7 .,— J enaa?
Property Tax ID #:
Site Plan Name:
Project Name: 1-.'a �1 Ma.n 4 112
DETAILED DESCRIPTION OF WORK:
roN A
Sele tz
AW
CONSTRUCTION INFORMATION:
Lot No.
Block No.
:5
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
Electric — Plumbing — Sprinklers T Generator Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 53 0% a 0D
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name_ b4t3 .1 Le ryl'on
Name: ' t 5 -
Address: JDf2QLS L()C2Cu- —b .
City:,_1-yn s-en State: F
Zip Code:, Fax:
Phone No. D1 Z ` Z� 2 -- ('o S to _
Company: a.r(c�i1�Cls � �G
Address: 00 6Qx (� i
City: 5�-�-4' State: L
Zip Code: 3— ��J Fax:
Phone Na
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail-= Lr(,C n d s AC 6Q
State or County License (: A C Dk5T 1 1 b
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:( Not Applicable MORTGAGE COMPANY: Not Applicable
Name:_
Address:
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: __�L Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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 Horne 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 l 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 JOB SITE BEFORE THE FIRST INSPECTION_ IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ;�Gy
COUNTY OF
efore me
The forgoing instrumelt as acknowledgVby
thi� day of o
The forgoing instrum
this day of L
was acknowledged -before me
20by
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y�a-s v y" 1 j q
Name of person making statement.
Name of person making
statement.
Personally Known OR Produced Identification A
Personally Known
OR Produced Identification_
Type of Identification `
��i
Type of Identification
Produce
��
Produced
°&a . JOSE TAPIA
68SE TAR;'��"
Signa re of Notary P .: , e OtfroridFt )State of Florida
Commission # GG 215487
ignat re of Notary P
State of Florida
-9 a_ ommassaoh # GG 215487
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Commission No. t ya Notary Assn.
eased AMID
Commission No.
ofo' My Comm, Expires Maya, 2022
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