HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR AOPUCATION TO Bt ACCEPTED LI
Date: -vs 15 Permit Number: I S I 13
SCANNED
Building Permit Applicat'on BYE+,,
Planning and Development Services at, Lucie COD*
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of linewg �I
Address: _ V L,0,' 011 a I U
Legal Description:
Property Tax ID #: 3 �22 OC7ol — ' Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
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ONSTiRUCfION INFORMATION
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❑HVAC �GasTank
ispermit—thee
❑Gas Piping
a
in _Shutters
❑Windows/Doors
❑Electric ❑ Plumbing
❑Sprinklers
❑ Generator
❑
Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 1','-� -�>CLc:)
S Ft. of First Floor: _
Utilities:llewer ❑Septic
Building Height:
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Name Act'E.aS VannPc �cri)
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Name: 'I dA[ �SSor\
Address: C7 ` * L f
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Company: r1+4Z dLC7'iQ0
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City: Stater_
Zip Code: 331 f;63 Fax:
Phone No.
Address:
City: n A dam_
Zip Code: Fax:
Phone No.�)Bg, U U� -
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State: -F L-
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E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: n CNf
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State or bounty License: i�C
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If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
,'SUPPLEMEN_TAL-CONSTRUCTiIOim2r`EN LAW..INFORMATION -a<� 77
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DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone:
State:
Address:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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, 1 do hereby agree that 1 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 concurrencyreview: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TOO Your failure to Record a Notice of Commencement may result in your paying twice for
improvements t you operty. A Notice of Commencement must be recorded and posted on the jobsite
before the first i specti . If you intend to obtain financing, consult with lender or an attorney before
STATE OF FLQWUA STATk1DF FLORIDA
COUNTY OF 1 tA" COUNTY OF C_Gkli Vd o
i a_
The forgoing instrument was acknowledged before me The forgoing instru entm was acknowledged before me
this !J day of �. )J0JhJDP_V . 20 J,�by this 2, ,day of n 1 �1 ��CQ,r 20 ,�J by c,
Alberto Serratos Lazcano
(Name of person a wledging) (Narpe o p e son acknowledging)
:a
(Signs ota ublic- State of Florida) (Sign 1i urn of f N ota1ry�(u tic- State ciFlorida) "'•
Personally Known �OR Produced Identification Personally Known � OR Produced Identification
Type of Identification Produced Type of Identification Pn duced
Commission No. • ...;':y..0eal) CRISnNADELDADO Co mission No. 1-f-' A2-lrj (Seal'yol'A AHMANDOLA
MY COMMISSION 6FF 9023 0 Nuruy Public • State of Ff
E., EXPIRES: March 16, 20ti My Comm. Expires MiS
••,q,k,°• Bonded ihm tnPumkunderrmmrs CommisslpofFF.U9t
Revised 07/15/2014 1-
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