HomeMy WebLinkAboutgarciaAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'gLzo 0 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 V/
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: 1p/al';diI?
PROPOSED IMPROVEMENT LOCATION:
Address: 5 %��f- ACSStf
Property Tax ID #: 5-0 -
Site Plan Name:° G'te ✓� �h�o�rl1 �rJ'I SP�f7eh-i ®nl� Z
Project Name:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional 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:
Cost of Construction: $ &J2 •DU
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE;
CONTRACTOR:
Name i<U/S -'41C i-a—
Address:,�_7 q Ll IW5S ct&-- 7E
Name: &,G� /,� � &r
Company Z ilypa/7V( /
City: ��e� State: �z
Zip Code::_;W&Z Fax:
Phone No._T32rZ ?-
Address: I.5�7 Sc S��el>`Gi Al
City: �0 � J��%r✓Gf� State: FL
Zip Code: St SS Fax: 772- &73-33L
E-Mail Aaln( O,,Oe-rMC e V&6e0 C�
Phone No 772- 77 3�Z�- 7
E-Mail i/
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License CAf A4Q :l 3'
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requirea.
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: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
_ Not Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_Not Applicable
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 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:'
Sign re o O r/ essee/ ontractor as Agent for Owner
Signature of Contractor/Li nse Holder
STATE OF FLORIDA _^
COUNTY OF 5T Lyc. —e—
STATE OF FLORIDA
COUNTY OF .5l �
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 6je-b 20 20 by
this day of F S 20 Z-0 by
Name of person making statement. t
Name of person making statement.
Personally Known °,Q9Troduced IdeatifirajiQi
Personally Known 1'd" Ucedldtntificatioq:i
Type of identification =r° `� Notary Public State -of Florida
Type of Identification - �c
+ •? Commission #i FF 971317'
Produced = -
Produced 'r: • ' • ° notary Public - State of Florid
•-,�� ��.�' My Comm. Expires Mar 14, 202t1
_ t,f,°°°,
Bonded through National Notary Assn.
+ Commission � FF 971317
_ '� :;
y
�7���1Ar M Comm. Expires Mar f4. 20
.
"����"°"° Bonded through National Notary As�
10/ 11U,_,
(Signature of Notary Public- State of Florida)
{Signature of Notary u iic- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
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DATE
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DATE
COMPLETED
Rev. y i/ i5