HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
tLNr
R Iim 7!7
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Permit Number:
Building Permit Application
Commercial Residential`
PROPOSED IMPROVEMENT LOCATION:
Address: 7GO 1 Flori Ntl ko Ave. �o(-' Y' e_CCe FL
Property Tax ID #: i 1 — GCY, " () jq 16 — 00d — -7 Lot No. 2 7
Site Plan Name: D'o6_1(. Luz )►�'QACP- Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
C
e. if C-`rT I' pc),i"k: 15 (C4 CIF iluiv'E_
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
Mechanical Gas Tank Gas Piping _ Shutters Windows/Doors
X Electric _ Plumbing Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ kI i G 7 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
Name E&Wi(x �UL�f'U�
CONTRACTOR:
Name: /4JCCIf lick
Address: 7 �1 ��C� r i�On ►iC'
Company: c n
En te,�
ri ` 5 Inc.
City: ucO V'%uce State: _�L_
Zip Code: �'; �fl Fax:
Phone No. 7-72 45%,l11
Address: -7575 Kio 5
,, nie
2KMJ. q
City. Ofkkr\�0
Zip Code: _5Z811q
Phone No ?;z 1 539
c�Fax:
Stater
WO goo 20'D7
F-Mail: L' 611 iUVe-C 2-0b Z [(2 94co a Ce4n
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail QOI i h fw(3
; I C�
State or County License
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: 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 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."
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Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ( ?'(Cyfig& COUNTY OF_ L uy'
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 20 by this of ,V+^i I , 20_20 by
AU `day
4�
C�V•n �{) � �LZ I�a,U elf �c1+o
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification (
Type of Identification Type of Identification
Produced F Produced EL DL
. F VINICIUS S ANSELMO WNICIUS S ANSELM
MY Cow ISSI0
G023717 / //�- :': MY COMM15b10N # GGO 36
7
'-4,Z,.r� EXPIRES Aug5#Z
(Signature of Notary P to of Florida (Signature of Notary Public- Sta e o I •rida) 2
Commission No. lJ+ a23�I-7 (Seal) Commission No. ���"fU�� 7 (Seal)
REVIEWS
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ZONING
SUPERVISOR
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MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19