HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY
10 St. Lucie County RECEIVED-
-- - -
Building Permit Application JUN 9,K ,niq
Planning and Development Services ST. Lucie Count
Building and Code Regulation Division y, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
v.
-PRO POSED.IIVIPROVEIVIENT LOCATION-"'.,'?
Address: 240 VV ALULA ti I
Legal Description:
Property Tax ID #: '; / �� �� �— 0 Z 0 0 b _ ,� Lot No._
Site Plan Name: Block No.
ProjectlName:
Setbacks FrontX Back: Right Side: X Left Side:
DETAILED DESCRIPTION OF 1NORK II
Aaaltlonal worK to ne errormea unaer tnls permit — cnecK au apply:
11�IVAC _ Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
ElElectric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 300 S Ft. of First Floor:
Cost of Construction: $ 2350 utilitiesSewer Septic Building Height:
OWNER/LESSEE
' CONTRACTOR
Namehomes with style Ilc
Name: Jorge mercado
Company: decorative concrete specialist of south fl
Address:240 w aldea st
Address:
City: Port saint lucie State:fl
Zip Code: 34982 Fax:
City: port saint lucie State:fl
Phone No.
Zip Code: 34983 Fax:
E-Ma'l:
Phone No. 7875469667
Fill in;fee simple Title Holder on next page ( if different
E-Mail: dcsofsouthfl@icloud.com
from the Owner listed above)
State or County License: cbc1260973
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: „
DESIGNER/ENGINEER: x Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:'
Name:
Address:
Address:
City: II State:
City: State:
Zip: I' Phone
I`
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
_
Name1'
Name:
Address:
Address:
City: I
City:
Zip: Phone:
Zip: I' Phone:
I
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 jobsite
beforethe first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencinu work or recording vour Notice of Commencement.
wy,\
Signature of Owner/ Lessee/Contractor as Agent for Owner
Si ature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA I
COUNTY OF .' )(I��
COUNTY OF L Lb�C',I F,
The fo' oing instr4pient was acknowledg before me
this day of 20 by
The forgoing instr ent was acknowledge before me
this � day of 20 by
AAWj_ �_u �►��,� �r
1rt K Levy SSeu-
I; Name of person making statement /
Name of person making statement /
✓
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification _
Type of Identific
Type of Identifiqattion
Produced
Produced
(Sign'' of Notary Public- State of Florida)
(Signature of Aotary Iii..%Qtg of Florida )
,�`"RYP''�
Com Ission No. , ,p %- KAREIN LSEN
`�°tipRY pV�
COmmI5510n No. n" ate o F�SSeauIELSEN
= Iorida•Notar
rate of Florida -Notary Public
°P= Commission .# GG 207484
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o'.r Commission # y Public
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°'�•O ` p GG 20748 4
°''�nm�` y Corrmjsslon
My Commis i
F
June 12, 20
2
22
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DATE.
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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