HomeMy WebLinkAboutCicioPermitAppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ — Permit Number:
`1 1 _u c-
�.
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 J
PERMIT APPLICATION FOR: �f=
PROPOSED IMPROVEMENT_ LOCATION:
Address: I . 6, `R a "7LL woo
Property Tax ID #:
Site Plan Name:
Project Name:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
i�r�X - 0� 0� rG 1' 1 t,�1n vir
r� ' b1C K7 ChG i n L
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under, this permit -check all that apply:
_Mechanical — Gas Tank .—Gas Piping Shutters Windows/Doors y_ Pond
_ Electric — Plumbing Sprinklers _.. Generator Roof _ pitch
Total Sq. Ft of Construction: Sq. Ft,. of First Floor:
Cost of Construction: $ . Q 300=� Utilities: .—Sewer v Septic Building Height: —
OWNERAESSEE: CONTRACTOR:
Name Q Name:
Addrj.! �CompanyUQ
F s: �C .
City: . p1 State:�L Address: 01 ^,w- (-'0z
Zip Code: 8 Fax: "" City:�'
Phone No. oi� - Stater
L.1 Zip Code: Fax:
E-Mail: _ •C "PhIne N -
Fill in fee simple Title Holder on next page ( if different E-Mail r
from the Owner listed above) State or County Lice se�
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. —
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip: _
Phone
____ Not Applicable
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City; State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
—Not Applicable
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County 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 Cnmmanr1nMAn+
i
Signature "Owneressee/Contractor gent for Owner
STATE OF FLORIDA
COUNTY OF _ ,C j.
Sv,arn to (or affirmed) and subscribed before me of
v ysical Presence or Online Notarization
this day of MdYG11, 202J[ by
>1 It -J- z
Name of pf rson making statement.
,,ki
Personally Known Y_ OR Produced Identification
Type of Identification
Produced
tz>ignaiure of N t —'
+t;�YPRICHY GOMES, JR.
Commission No. 4�. �0jubuc�g�aAlp of Florio
+ ssion # GG 966763
Y CO(nfnJSSion Expires
Signature of Contractor icense Holder
STATE OF FLORID
COUNTY OF SrF . l J
Swprn to (or affirmed) and subscribed before me of
_e Notarization
9sical Presence or Online this day ofmm[jr'(ji _____ , 202Lby
l�r-nr�h Y7 _.
Name of pe son making statement.
Personally Known J OR Produced Identification
Type of Identification
(Signature of Not - ■■r.�,�,
GCiMES, JR,
Commission No. = ° ' Publi - to of Florio
A,. issio 1966763
MY COmmissi n . oxpirBS
REVIEWS FRONT ZONING S OR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED