HomeMy WebLinkAboutSLC Permit App - Monica JimenezAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: T P —j L-j r?Lij_ Z7 , °j z-L i
Permit Number:
o�
Building Permit Application
Planning and Development Services ~ ~
Building and Code Regulation Division Commercial Residential � 2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR, -
PROPOSED IMPROVEMENT LOCATION-,
Address: L A 2 q iAj jkb g ixri 0,,LT,4 /L-1' - :, - I-) S� j �-?'/ 2
Property Tax ID ##:
Lot No. 4
Site Plan Name: J i �-1 i✓uL Z i L�stt �i�1� ��� L
Block No.
Project Name: /,lt'.5 i7riL 0 i; L i-L-w
DETAILED DESCRIPTION DF WORK:
i%j-r ! i;—
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
�7h t L F {%C J-> J> r c Y ALC'L
Additional work to be performed under this permit -check all that apply:
(Affidavit required)
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 Construction: $ 2 : S�, ? Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name
Address: 1,2Y-I Wl� Its inlc� _T 'i�l�tcL;
City: Luc, t State: PL-
Zip Code: 3 A ? 2_ Fax:
Phone No. � 1 ,- 0':5� 71 E-
Mail: Mv,gi rht4LtlrtY/�OL Y f Erg
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: _ l�+[sscccrL i4i LL= U
Company: A tf�A-,EH=r f L-MLC-
Address: '' Si &J Lj, i=nf7 iLL �,L
City: Pb,t7— ri- LLet L State: Ft --
Zip Code: .?'/ V96 Fax: `rig. Kc�i3 a z-72
Phone No '772-- 5t'2 -,oZ23
E-Mail MICi, ce /i Z
State or County License C 6 ci r-S-Z 7 -T 7 e
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 iNFORMATfON:.
DESIGNER/ENGINEER: ,L Not Applicable MORTGAGE COMPANY: Name: ,Not Applicable
Address: Name:
City: Address:
State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY:
Name: Name: —Nat Applicable
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 far
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County an osted on the jobsite before the first inspection. If you intend to obtain financing, consult
with fender or a attprney before commencing work or recording yojr Notice of Commencement.
A
Signature of r'L sse Con #actor as Agent for Owner
STATE O . LORIDA
COUNTY OF YT` Luc c
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this V7 day of - � ►Yl 2Q 21 by
L3 l� GitLE CL� �lf d �-L^�
Name of person making statement.
Personally Known OR Produced Identification
Tye of Identification Pro uced
ry 4 i
(Signatur f otary Public- State of F, id }
Commission No. �"I 1Seal}
Notary Public State of Florida
Crystal E Naylon
My Commission GG 029549
a Ewpires 11/0612023
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE REVIEW REVIEW
RECEIVED
DATE
COMPLETED
ReV