HomeMy WebLinkAboutGonzalez - Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1� �I a1 Permit Number:
ST. Lt1�lE,
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v `isuuszu� Building Permit Application
Planning and Development Services
Building and Cade Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address:
Property Tax ID#: 3igloi - 5)0 - 00by- D/i/)-3 Lot No.
Site Plan Name:
Project Name:
New Electrical Meter
Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit- check all that apply:
_Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 15, 911. "
_ Gas Piping
—Sprinklers
Block No.
_Shutters Windows/Doors _Pond
—Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
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Name 'ri-o \Or.�fl l�()nyxkt-1- VsRp-
Name: ii'.ClL- WCAOn
Address: 30LI ttiiOtYW
Company:
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City: 'dock.\ %. 1Lv� Ag . State: �
Zip Code: 3y9S; Fax:
Phone No. -7 a. 1 O - 5,01 T9 E-
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Address: Ce,TZS1 )a. 44r_ 1n)O521h,
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City: (,)7fea&n&&feS
Zip Code: 33W,,2, Fax:
Phone No k6LA) I44%A - 4c3 I O
State: FLL
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Mail: hct.2 'fo-hb0-COM
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Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Wes' Fra Ir11 B�Fw6�&) c>X
6C60/S ji70
State or County License UC f .' ,3
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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.
SUPCO'INFDRMATION , .w
DESIGNER/ENGINEER: _ NoEApplricable
MORTGAGE COMPANY Not Applicable
Name: Name:
Address: Address:
City: City: State:
Zip: IMne Zip: Ph ne:FEE SIMPLE TITLE LDE _ Not Applicable BONDING COMPA Y: _Not Applicable
Name: A Name:
Address: Address: Irk
City: City:
Zip: Phone: Zip: P I
one:
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 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 our Notice of Commencement
Signature of Con ractor - o�er Builder as applicable
ev
STATE OF FLORIDA
COUNTY OF Tcelrl J�,t`_AC1n
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Notarization
this '�!" day of 'SD«eynbnr . 20.11 by
_Online
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Pr duced
(Signature of Not ublic- S to of Florida)
Commission No. :;t�`r °ti''•. L })ORELLANA - r
,�•.�. pubTlc - State of Florida
a? Commission 9 NH 187012
'%?;ar
Comm. Expires Oct 15, 2025
Bonded through National Notary Assn.
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