HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: IS' 2L (S W 01D% Permit Number: r 0-0-94
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St Lucie County RECEIVED
Building Permit Application
Planning and Development5ervices MAY 0 2 2018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-
ST. Lucie County, Permitting
Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED iMPROVEMENT.LO;CAT10'N „
Address:
Legal Description:
C%
Property Tax ID #: -N2 5 - :403 - o2o!2 - 000 - Lot No. PJ 6
Site Plan Name: AW &0!4 Block No. ZL
Project Name: MtW/oM
Setbacks Front Back: I Right Side: Left Side:
Adcutional worK to oe ertormea unaer tnis permit - cnecK an t at apply:
O,HVAC Gas Tank I ❑Gas Piping _ Shutters Q Windows/Doors
Electric El Plumbing ! ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 6;0 S . Ft. of First Floor: LyA
Cost of Construction: $ Zdo0 "— Utilities: o Sewer Septic Building Height: _
0WN,ER%LESSEE '�
CONTRACTOR: P 1; ,I
Name,&r6,-l`C. AA1,,6 8
Name: Ruben r A(tryo
Address: P,c3'41 C-xII.6M Cr te_
Company: Arro o (�i�-1, Eon _
City: QNr-�- --}. LA State: ,
Address: 117A S4,
Zip Code: kAA52 Fax: z 5� r '> Lifer
City: %,"I. ",-e State:
Phone No. —
Zip Code:3k4 P Fax: =T42.5l- GZ 4 o
E-Mail:
Phone No. 597_ _24-4 6 M5
Fill in fee simple Title Holder on next page (if different
E-Mail: 1?06'., .-u��4� .���.sv /�4r1
from the owner listed above)
State or County License: CRI &S 5C4
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLE -MENTAL CONSTRUCTION LIEN
LAWINFOFtMATION
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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:
I
Name:
Address:
Address:
City:
I
City:
Zip: Phone:
Zip: Phone: I
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 gral ting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owner's 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 pelrmit, 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing -work or recording your Notice of Commencement.
2-1- �Ti
r
Si re of Ow ac or as Agent for Owner
Signature of Contras or/Lis ns Holder
STATE OF FLORIDA j
STATE OF FLORIDA
COUNTY OF, <TI . LUCr�?_o
COUNTY OF _ Y • LLx_-4'
I
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _Z. day of � 201B by
this � day of 20LL by
�c m F Argo
AcLolo
Name of person making statement i
Name of person making statement
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of ldentific tion
Type of Identification
Produced �2-
Produced FL ,7L
(Sign re of Nota " i6tat )
(Signature of otary e c�+4�Ia11�f GRASSO
`c MY COMMISSION #,FF998252
=' MY COMMISSION # FF998252
Commission No. EXPIRE�$bgj 02, 2020
Commission No. EXPIRE($MiQ 02, 2020
(407) 39"153 FlorldallotaryService.com
(407) 39M153 FloridallotaryService.com
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Rev. 8/2/17