HomeMy WebLinkAboutBuildingt Permit Application_ _ .ray. '�e� _ _• ._ _. .4 _
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
befor 'rst inspection. If you intend to obtain financing, consult with lender or an attorney before
co encing Work or recording your Notice of Commencement-.,
of Owner/ Lessee/Contractor as Agent for Owner
Contractor/License Holder
STATE OF FLORIDA STATE OF FLg!t_ILj(-
COUNTY OFF � COUNTY OF�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisa day of 202Q by this _2� day of PMf(1 .20 20 by
(Name of person acknowledging)
re of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No.
REVIEWS FRONT
COUNTER
DATE
RECEIVED
MPLETED
(Name of person acknowledging)
re of Notary Public- State of Florida )
Personally Known_ OR Produced Identification
Type of Identification
Produced
KIMBERLY MENDEZ
r KIMBERLY MENDEZ
MY COMNP #GG234874
` EXPIR
Commission No.
oSrB ..,,be
`� MY CO #GG234874
Jl1L 04.2022
Bonded through 1st State insurance
EXPI ES: J L04.2022
��° Bonded through 1st State Insurance
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
Commercial Residential X
PERMIT APPLICATION FOR: A IC
PROPOSED INPROVEMENT LO TION:
Address: yj -qQ
Legal Description
Property Tax ID #:
Site Plan Name: Lot No.
Project Name: Block No.
Setbacks Front Back: Right Side: LeftSide:
[DEET�AILE�DDES�C�RIPTfIONOF WORK:
A /C Charm e nu4 QAJm 3
S R-
VCONSTIR�UCTION INFORMATION:
Eo
a pe orme un er t is permit — c ec a t at app y:
,Mechanical — Gas Tank —Gas Piping _ Shutters —Windows/Doors
Electric _ Plumbing Sprinklers ^ Generator ^ hoof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: KCO:NTRACTOR:
Name
Address: -" r�
City: State:,�L
Zip Code: Fax:
Phone No,
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Company: ICA
6ades pi,.
Address: G—r
City: e o 73e44State: Pk
Zip Code: i2z Fax:
Phone No 11
E-Mail 1r ,'P ea;1•Com
State or County License CAL191910c
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.