HomeMy WebLinkAboutPermit Henriquez.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ()31c]Permit Number: _
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial _
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Residential
PROPOSED IMPROVEMENT LOCATION:
_1 .
Address:k"'� P)c
Property Tax ID #: 3 ' vli " I Lot No.
Site Plan Name: Block No.
Project Name: 1OPIA le-.
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
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 Construction: $ i F U� Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Jcona H
enri cw c-
Name:
Company:AW,°
Addre (�
1
Address:
City: '� Stater
Zip Code: F , Fax:
Phone No. 4 1, - " E-
City: r
Zip Code: Fax:
Phone Now r~ ) '
State:
C)
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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:_
Address:
City: _
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 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 FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/C tractor as Agent for Owner
Signature of Co tractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sr Lue;C
COUNTY OF t' cl t
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this IVA day of Sul 2010 by
this 14 day of '11,l 6 20 2.0 by
�_►Mstlu t ice,
20^(Jol R�(,Le
Name of person making statement.
Name of person making statement. S
Personally Known OR Produced Identification �q_
Personally Known OR Produced Identification f/
Type of Identification
Type of Identification
Produced l= Pb
Produced 1= L D L
(Signat e f Notary Public- State of Florida }
(Signature of otary Public- State of Florida }
Commission No. ,--
Commission No. 66� AUDREfSeOJI)MER
t 7 ',AUDREYSTUEHMER =_° -- Notary Ppblic • State of Florida
Notary Public - State of Florida
: Commission # GG 317544_�
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DATE
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DATE
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Rev. 2/ 7/ 19