HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Plonning and Oevelopment Services
Building and Code Regulation DivISion
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: () -1 Faux: (7 )462-1578
PERMIT TYPE: 6� � _ �-�►.
PROPOSED IMPROVEMENT LOCATION:
Address: `',{�i y S �f c�t�r.f rot+►.a'
Property Tax ID # -.
Permlit Number:
Building Permit Application
)-0 �(fl(a�-�53Y .,
Site PlanName:
Pro# ct tame:,
DETAILED DESCRiPTION of WORK:
CONSTRUCTIONINFORMATION:
Commercial
I"
Residential
Lot o -
Block No.
Additional work to
be performed under this
permit -check all that
apply-,
Mechanical
Gas Tank
— Gas Piping
Sfiutters Windows/Doors
S. Electric
� Plumbing
Tote Sq - Ft of Construction'.
Cost of Construction-,
OWNER/LESSEE:
Sprinklers
Generator
Sq. Ft. of First Floor:
Roof
Utilities: _- Sewer Septic Building Height-
Name JuanQuinteros
Address:2 S11 Wade Dr _
city.
Zip Code: 3 953 Fax:
phone o.
772-979-4956
E-N ail: jessq 01nter s@ it -co 1
Fill in fee simple Tale Helder on next page if different
from the Owner listed above)
CONTRACTOR:
[Name:
OVIn YYC�CCLLL-
o ran pa n y ;"-1
____�
Address:
City:
,5W.0 S I
TLuce
Zip Code:��' 1A tf S�3 _Fax:
Phone No a �" Z ' 3 Z3
E-Mail
State or County License
If value of construction is or more, a RECORDED Notice of CommencMent is re Uired.
if value of HVAC is $7,500 or more., a RECORDED Notice of Commencement is required;
Pitch
State; FL-,,
C 14S�A
►J
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ E1R:
Not Applicable
Name: Address-
City: State:
is Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address;
City.
Zia: #ors:
Not Applicable
MORTGAGE COMPANY: � Not Applicable
Name:
Address:
city: State:
Zi p q Phone.
BONDING COMPANY:
Name,-
Address. -
City..
Zip: Phone:
Not Applicable
OWNS CONTRACTOR AFFIDVIT. Appiication is hereby made to obtain a permit to do the worm and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
t. Lucie Count mad e no representation that is granting a errnit will authorize the permit holder to build the subject structure
which i in con ict with any applicable Home Owners Association rules, bylaws or and covenants that ma re tract or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions wfri h 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 Honda Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: morn additions,
caccessoiry 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 RESOD' IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCINC, CONSULT
WITH YOUR LENDER AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COM ENCEME T.-03
w as e ow � n r Lesse /Contractor as Agent for Owner
STATE OF Ftc�Q.ucie
COUNTY OF
The f rgoing instru ent was ac nQwledged before me
rid by
this� day of � o21
VAS
Marne of person ruling statement.
PersonaMy Known wn _ X
Type of Identification
Produc
OR Produced Identificiltior) .
a Beltran
sswu: cc2�zse
Signature of Contractor/License molder
STATE OF FLORA
COUNTY OF- f.`• �
The ing in tro yen as acknowled e efore� rye
rday
this of 4T by
Marne of person making statement.
Personally Know �.. OR ProdLlced Identification
Type of Identification
Produced
L 1%
i
gr� ure of Notary to MW � (Signature of Notary Public- tea F. �
3 }} pub Sty of Flon
l Commission ion o.�,�7 j =ve
commission No. -. - l - 1Mir Commission GG 93M
Exprss 1 lD=3
- ..r rT70
��TURTLE EVIEW FR T fi s
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE l
RECEIVED
SATE