HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
ST.1.(.ICIE -
C.•IVT�Y
F O R 1' D A
Permit Number: ,�, 161 - b &,.5'-)
A r"51" O
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
PERMIT APPLICATION FOR:
Commercial
CBDG Funding
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:.2-6_Si 2 _ n on % l i
Site Plan Name:
Project Name: _
DETAILED DESCRIPTION OF WORK:
N.
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
� 2p21
\PIN
Residential
(Affidavit required)
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction:
Lot Now
Block No.
V Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ju)c 1-L(ram o ,.f l��f��(
Name:
Company:
Address: 110 Ll ILLS! a �0116=
City: J2 &R /'--c- State.F
Address:
Zip Code: Fax:
City: State:
Phone No. 3 i Ca _ �I�� ���� E-
Zip Code- Fax:
Phone No
E-Mail
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
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: _Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:.
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name;gfIc'Y1 LAtrz1fl: _g� [ _
Name:
Address: / 1 t3 !J ViSMq Za af:r—,
Address:
City:V1o2CE F'L_
City:
Zip: Phone: Z10
T
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtair
I certify that no work or installation has commenced prior to the issuance of a
permit to do the work and installation as indicated.
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 for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the job ite before the first inspection. If you intend to obtain financing, consult
with lender, or an attornev before 6ommencing work or recording vour Notice of Commencement.
HEATHER $URFORD
0
°�6;State
f�
;2o,PPYP(
of Florida -Notary Public
igna ur essee/ �a gent for owner®oe
Commission # GG 183217
My Commission Expires
°iv February 06, 2022
STATE OF FLORIDA
�,..
COUNTY OF rr��
Sworn to (or affirm d) a d su scribed before me of Physical Presence or Online Notarization
this 2-day of (.-t (r 2014 by
.0 t
Name ot person making statement.
Personally Known OR Prod Iden ' ication
Type ofldeio r uced
(Sig a of of ubli tate of Florida)
JosePh Gomez
ommission No. (Seal)
Commission GG11i14 04
oQ Expires:
November 1 Ii, 2021
Bonded thrll Aaron Notary
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev 5/ZU/Z1