HomeMy WebLinkAboutBuilding permt appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z&7 nJ.z Q Permit Number:
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 _Y
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Address:
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Legal Description: __Y1;A3_e.n
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Property Tax ID.#: 02,30? 3 - %d 1-j90 qS bQD _ 7 Lot No. d
Site Plan Name: Block No.
Project Name: tA'CrY '6( fly
Setbacks Front Back: Right Side: Left Side:
Additional -work to be performed under this permit- MIT a tat apply:
_Mechanical Gas Tank _ Gas Piping Shutters Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
s
Cost of Construction: $ T� a_Utilities: —Sewer —Septic Building Height:
Name e.4 d�l -�~ Name: A
Address: Sl�l� 1.ar1 2Sorne i��' e I M L, Company:CaAJz_"I
City:. _Er,. L e-t c f State: i— Address:
Zip Code: 3 ys Fax:. T City: & /; e.4ec State: Al
Phone No. '! 67- 0 A 'l - Zip Code: 9 14 Fax: 77Z- V6/-diJ�-r
E-Mail: 14 Phone No2, _�^ VhZ- a//6
Fill in fee simple Title Holder on next page ( if different E-Mail Sky C ow 4/aclioo . Co^l
from the Owner listed above) State or County License 4CCGt3C/S/.5�0�___.
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not ApplicableMORTGAGE
OR Produced Identification i%
Name:
COMPANY: �/ Not Applicable
Address,
Name:
City:
Address:
State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:/
BONDING COMPANY: Not Applicable
Address:
Name:
City:
Address
Zip: Phone:
City:
COMMACGi89841
Zip: -_1 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
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which is in coct 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 our Notice of Commencement.
S gna re of ow r/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA; i . [U , ,T
COUNTY OF
The for oing instr ment was acknowledged before me
this day of -TL4 L 202,0 by
Name of person making statement.
of Contra
STATE OF FLORIDA
COUNTY OF
Holder
The forgoing instrument was acknowledged before me
this,2 day of _TU LV 200 by
15 a [ C
Name of person making statement.
Personally Known
Type of Identification
OR Produced Identification i%
Personally Known
OR Produced identification
Produced LC)U1 4
wva LlC2>75
Type of Identification
Produced FUkL7A•
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."'11va ORLANb() VAZQUEZ
ignature of N ary Fu
-State of 11or'd
Commission No.
NotarycState ofFtoricl
GRIP NUQVAZQUEZ
COMMACGi89841
Commission No.
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My Comm. Expires Feb 26, 2022
Notary 189841
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My Comm. Expires ^b Ass
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