HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COM'rc.Lti ED FOR APPLICATION TO BE ACCEPTED •""
Permit Number:
Date:
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 APPLICATION FOR:
Address:
Building Permit Application
Commercial/ Residential
L
Legal Description: Za .30 y0 d1.?ODA' af5 Off,, �F,.W Z30�b,
Fr af-s yz OF sc yy C + , 6& Act C d i 15-19-0:r4)
Property Tax ID#: 4e/ 12W —ODd�Z
Site Plan Name:
Project Name: Zvi /i Af S/Ac
Setbacks Front Back:
n?sPe AAekGS
Right Side: Left Side:
Lot No.
Block No.
MMechanical _Gas Tank _Gas Piping _Shutters _Wind ows/Doors
'✓Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
DU
Cost of Construction: $ �S, 20 0. Utilities: —Sewer _Septic Building Height:
O NER/ ESSEE;
CON A PTO ;;
Name 2Pr lFL.:
e �:� :�•,
Name:
z
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Address O-'57�; "'°ST ii
Company: @ S
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di 5` i.
City: .V e-.CG°P State: �L
Zip Code: 3� Fax:
Phone
Address: - 0•� ' -
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City: ✓ 5a
Zip Code:, A(0 Fax:
Phone No - o -
State:Az
E-Mail:$ ? ' �2Z12 ip//i (d�/l�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail_
State or County License Poe /Z.Sfio 10929
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUrPPLE , ENTAL CONSTRU
N LIEN LAW INFORMATION:
DESIGNER ENGINEER"' _
NameA.Jr
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: o D S%
Address:
City: iv /4-CS
Zip: :g 5O Phone 9S'
State: )c:/::
i( �7�
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
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
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
zf�(.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of ntractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF i . J 01L
COUNTY OF M i z�� i
The f?r .ng instrument was acknowledged before me
I .
The forgoing instrument was acknowledged before me
this day of r-•i Ate? 20 17 by
this jX day of "A,,? 20_!y by
71 . ,e, bZj ,
1 r i II ,. LEE
(Name of person acknowle Bing)
owledguMl
(NamzofNotary
ature of Notary Public- State of Florida)
(Si Public- State of Florida)
Personally Known OR Produced Identification
Personall Known V OR Produced Identification
Type of Id
Produced T?i �in C e a ��
Type of 1 JAVIER SOBRINO
Produce wr�uussl u•«Muzs
EXPIRES: February 20, �fi0Q20'6I'
Commissl .�, d....,v� ryPublic 1123 M
I- EXPIRES: February 20,2020 F\
COmmISs ng}r!F'' Bonded Thru Notary Publle Under�r$pa
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