HomeMy WebLinkAboutBUILDING PERMIT APPLICATION'3
ALL APPLICABLE.INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: 11 r. %y Permit,Number: TV
I' ��> (:�•
RECEIVE'D
MR 1�ft'
Building Permit Application
NOV 1 3 2•01$
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (7 I2) 462-1553 Fax: (772) 462-1578 Commercial R cl ounty, FL.
FP APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:'
Legal Des
on: -�lnig 59 JANdirLQ At 'thy, Re,5eRUP-PNALP ,On➢e, -L s� 20
LI A nI
Property Tax I D #: 3 3Q_! r)CO Ai MO C Lot No.
Site Plan Name: Block No.
Project Namle:
Setbacks Front Back: Right Side: Left Side:
Re(4 of: ti-p-, --�- 01AN f- �J1�t11�1%�J 1Cp mv,\-Q5ioeb NO. -A AO-Vrso NQ fYl k,103aQ.03
Ro�F delr�'o�c-i�.�N J ,6,DRA1 -AA.e So 4oNLa 900 0ae-r-re�e woo -Jrvg��ll fji RAL_1Je 5eA-L NOA_IV, 050,16'3 1MOA i� O1Ai
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'v 6r1l1N')'Q 5v%W:�1A-�-MgXiM JnJusAv�p NDR. 15.OL51
0 Plumbing
qtion ' `1 C
Sprinklers
LlShutters
Q Windows/Doors
EGenerator "
® Roof `4 Roof
pitch
Ft. of F1rst;FJdor�r
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Sewer' 1{ S'epticK{; . Budding Height:
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Name V4 CkRA"P, M
Name:OMA+ 5. 5eigriPil jdeZ. .
Address: -13 n.�
Company:-Me_AJo
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City: [5 A !ry+ t)Ci (3; CQk) NA State: _L
Address: 5 al ki W l5R"h 1.eA 4 ,30-2-
Zip Code: Fax:
City: m%,A-W\z %AWe(v State: i;)-
Phone No. 3al Go 20
Zip Code: 33i) 1 LA Fax:
E-Mail:
Phone No.. �54, g6'1 ZA502
E-Mail: `'►nnn tR Q(; . Pe r �rn : ' _ �AA�t . fin-,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: CW_ 4i Il 33® '12 9
it value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address: ''Y °` r$'z''
Address:
State:
City:
State:
Zip: Phone
Zip:
"Phone:
FEE SIMPLE TITLE HOLDER:
•.,F Cam..,_
`, Not Applicable
BONDING COMPANY: _Not Applicable
-ii t. ..r
ame:
Name:
1
Address:
Address: _
City:. _._ ... _
City; .;
Zip:
Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work andinstallation 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 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.
i
Sig66ture of Owner/ Lessee/Contractor as Agent for Owner
Signature of C trac or/License Holder
STATE OF FLORIDA
STATE OF FLORIDA jr
COUNTY OF RdL
^^•' _-
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instru ent was, acknowledged before !me .
this day of `Fire P -m 6gc r 20 t9 by
this -_ day of , 20_j'& by
tAOL
--
N me of pe son making statement
erson making statement
ersonally'Kno OR Produced Identification',
Personally Kno OR Produced Identification
,
Type o entification �6S o 3ro $'S—a'�
pe o en tification ��,�� .
Poduced
Produced YP RAUL' NAVARRO
Commission,#FF972714
ANTONIOE.GOMFZ
(IISS)ONAFF913115
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EXaBtES;�(UG 2b, 2018
B6,dlhroughlstStete.lnsurance
11.�1 March 20 2020
(Signature of Notary Public- State of Florida,);
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
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tev. 8/2/17