HomeMy WebLinkAboutAguirre, Felix County Of PSL, Permit App, 10.20.2020All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - ao- mao Permit Number:
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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
Address:
Property Tax ID #: 3!a %- 1 /1-06p1 _00wo - 5 Lot No.Site Plan Name: //�� Block No. ---
Project Name: A6U /PQe i'Ces/ ence_
I DETAILED DESCRIPTION OF WORK: I
�dv�/ A6 kid v--
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit- check all that apply:
V&chanical _ Gas Tank — Gas Piping. _ Shutters — Windows/Doors
_ Electric — Plumbing —
Total Sq. Ft of Construction:
Cost of Construction: $ 00(7
Sprinklers — Generator _ Roof
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Pitch
OWNER/LESSEE::
CONTRACTOR:
Name
Name: Ti4/Yle� L. /,lJ/LL�A/YlS
Address: =W _771- S4r, ,
Company: i A r r
City. . S4!. L )C:ke_ .J State: !..
Zip Code:; Q ' Fax:
Phone No._ 'j 7Q - k 77,3 - SS 13
Address: 22,5 /y£ Prime, yi s l�L ✓c{
1
City: p6cf S'f. L-tJ(;! e State:
Zip Code: 3 Fax:
Phone No _7 7 a- 6o ,21-%6sQ
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License CA G / r/ a7911
u vaiu+e oc construction ss ;;sznPuu or more, a KtLUKULU Notice oP 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
Name:
MORTGAGE COMPANY: Nat Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: _A/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 BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LFJd6ER OR All ATTORNEY BEFORE RECORDiNG YOUR NOTICE OF COIMIMiENC T2'
Signatu a ner/ L ee/Contr ctor as Agent for Owner
i ature of or/Li s er
STATE F ID
STATE OF FLORIDA �
COUNT
COUNTY OF J>-
The forgoing instrument was acknowledges{ before me
this day of - Q- A40RAL J 20W by
The forgoing instrume t was acknowledged before me
this _QQ day of 2030by
r
para.l r r .2
0.it'S
Name of person makinA statement.
Name of person making statement.
Personally K wp„�„ Ll�c
Personally Known
T e of Iden r°-- 7
Ty _ osNoYary Public -State of Florida
„
Type of Identificatio ,•:PaYPu' ,
Notary Public -State of Florida
Produced =" Commission # G 9s6362
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Produced = "= ion # GG 956362
oFa�o�,. y Commission Expires
fill February 09, 2024
%*� tvly Commission Expires
�'0ii 5�``4�
- February 09, 2024
(Signature of Notary - State of Florida)
(Signature of Notary Public-16W of Florida )
Commission No.e5:(,0_ (Seal)
Commission No. 6 9'�L360 (Seal)
I
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Rev. 1