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All APPLICABLE INFO MUST BE COMPLIER 10R APPLICATION TO BE ACCEPTED
Date: `I//IO-® Fp Permit Number:00
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{ " Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: t30u4 UoDDiesione ur Fort Pierce, FL 34945
Property Tax ID #: 2326-600-0076-000-2
Lot No: 71
Site Plan Name: CREEKSIDE PLAT NO. 1 (PB 55-12 Block No.
Project Name:
DETAILED DESCRIPTION OF WORK
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ectrical 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 — Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Cons$��T— Utilities: _Sewer _Septic
Building Height:
OWNER/LESSEE:
-CONTRACT R:.
Name Lino Garcia
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
Address:8604 Cobblestone Dr
City: Fort Pierce State: FL
ZipCode:34945 Fax:
Phone No. 772 979-0112
E-Mail: Linog321@yahoo.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
- -- - -- -� •�•• •� �• ��, a --nuru wutme or t ommencement 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: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE BOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County andposted on the jobsite before the first inspection. If you intend to obtain financing, consult
with len.ger or attorney before commencing work or recording your Notice of Commencement.
re
as Agent for Owner
STAT F FLORIDA c
COU .n OF _�J U r� d
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _ day ofl9JV 202� by
L No
Name of person making statement.
Personally Known OR Produced Identification
Type Identificatson� C) t
Produced ��
_20 o a�o,� GG 2701
*= Commission #
Co m f5 ' & nny Commission Expir
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced .
(Signature of Notary Public- State of Florida )
Commission No.
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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