HomeMy WebLinkAboutBuilding PermitAll APPLICA LE ll�FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: q 124-:1) �7 Permit Number:
4111111111111
•:i�,p yll 3 ,,5 • ',' M MI
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 Residential
PROPu . OVEMENT LOCATION:
Address: �� V� j �� �� + V`� ��✓ t �i �� L c ��� K +�
Property Tax ID#: Lot No.
Project Name:
DETAILED DESCRIPTION OF WOR
CONSTRUCTION FORMATION: ;
Utilities: _Sewer _Septic Sq. Ft. of First Floor:
Cost of Construction: $ `"1�� •UL--� _ Total Sq. Ft of Construction:
FLOODPLAIN DEVELOPMENT PERMIT for structures exempt from Building Code that are in the
floodplain:
Nonresidential Farm Building: _ Temp. Bldg./Shed used exclusively for construction
Mobile/Modular for temp. construction office: Bldg. involved in distrib, of electricity:
Other: Fl000c Zone:_- BFE:_ Floodway? Y/N irY,
No Rise Certificate with supporting data attached? Y/N
All other applicable state and federal permits shall be obtained prior to commencement of
construction.
OWNERAESSEE.
ONTRFlCTOR:
NameA_- C= ��e_ �" Tn
Name.- LAC,(-\
Company-.CYj,�Cico%fir cQ -
Addres -^(+r
City: �-1 Spa- 0t-QILe State -a
Address:9717_(�) f` _U f r'l' 5,
City: _I - SV• \ -tom L j--rj_ State: ( '
Zip Code: Fax:
Phone No. -. K.�1 3\O Kd_ i��_
Zip Code: Fax:
E-Mail:
Phone No__Y_)2-.-���'' C7S
Fill in fee simple Title Holder on next page ( if different
E-Mail N
State o Junty L' ense2` ,
from the Owner listed above)
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:
INEER: _ Not Applicable I MORTGAGE
Address:
City: State: _
Zip: Phone /
FEE SIMPLE TITLE HOLDER: _
Zip:
Not Applicable
effy: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
City:
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 your Notice of Commencement.
Signer of Owner/ lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA jj ��
�• _/G
STATE OF FLORIDA 5\ j
COUNTY OF �- rLA�A
COUNTY OF
The for oing instru ent was acknowledged before me
The forgoing instrument wa acknowledged before me
this7dayof N�Ct4 12010 by
this _JLday ofI I LA%i 20 W by
AUC6 om 0 S
M
V'sUUA N J0S.
Name of person makingstatement.
Name of person making statement.
Personally Known V_ OR Produced Identification
Personally Known Q)`(*" OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
ARIEGONZALEZ
Ilc-State of Florida LQ
(Signature f No i"7to , -� i $Edl H ebt,2W2
(Signature f Iicl EZ
Florida
Bon rough NationalNotary Assn.
No.
i'Commissio6g6Commission
Commission orn?' My Comm. Exe9�27
!GG
Bonded through Nary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.1/9/Z019