HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED O ��
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Date n Permit Number: P
RECEIV96
Building Permit Applicatio MAR 0 3 2020
Planning and Development Services La. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
_Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: Rer4df .0dVa k' INC�UrJ
PROPOSED IMPROVEMENT LOCATION:. _ ;<
Address: 12174 Riverbend Trce, PSL, FL. 34984
PropertyTax ID #: 4422-502-0007-000/8 Lot No.3
Site Plan Name: LW122? Zr&BZ ZE5f�>&Al c = Block No.
Project Name: 14 r/
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iL 7 t ��
TION•.
Additional work to be performed under this permit —check all that apply:
XMechanical _Gas Tank _Gas Piping _Shutters'
_ Electric Plumbing _ Sprinklers _Y- Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 8Q0Pf Utilities: _Sewer _Septic
for
X Windows/Doors
Roof Pitch
Building Height:
OWNER/LE55EE° �'
°GONTBAG7dR
Nan' Fountain•Plaza lnvestments;LLC
Nd"m`e ��afY Inez, 1
Address 737 Sw Port St,Lucie Blvd
Colf,pari Quality Construction Concepts LLC
Y• -
_
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A�dreSS 4365,Sw Shadd,St
City Port'Samt Lucie, State: _
City Port.SaititLucie; t' State: FL
Zip'tode.34953 Fax.772772-0882
Phone No.772-873-0545
Zip Code: 34953 `Fax:
Phone No561-629-6421
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail qualityconstructionconceptsllc@gmail.com
State or County License31478
from the Owner listed above)
If value of construction is 52500 or more, a RECURDEu Notice or commencement is regwrea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPIEMNTAI CONSTRUCTION LIEN LASH INFORMATION?
m.�c;t. �:. .,
,k. :n
..�w '". r,..01 ,
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:,
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hel'eby 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 rbstrictions 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."
S' nature of Owner/ Lessee/Contractor as Agent for Owner
SignatureAfContractpr/Licen§doMer
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ST- 'Z> cif
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this20 day ofP6hT 20;Zo byjlipgt A2tL
thisdayofFf49AmAA4 20 20by
GAILMAAJ , aca
Name of person making statement.
Name of p rson making statement.
Personally Known X OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Praduced
,.`;kV-,, OSMEL VALDES
�III•�' >aVa ", OSMEL VALDES
�tP' :i° °4.; Notary Public -State of Florida
(Signature of Nota I # GG 356848
=,7„�,
(Signature of Nota5,fat ���GG 56648
mi slon Expires
,�, ,,a?.` My Commission Expires
,�
�"im"`� July 18, 023
Commission No. G J paQ , 2023
Commission No.
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