HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLe i C'J FOR APPLICATION TO BE ACCEPTED
Date: 1 1 ��� 1� Permit Numl
SCANNED
By
LS
s St. Lucie County
Building Permit Ap
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578. Commercial
PERMIT APPLICATION FOR: IA/ 1-NJ-)&'IJ
Address:
Legal Description: e64D oi0'lpw
51
\�c;l—oy��
errrmitting Department
St. Lucie COUyrty, FL
Residential
Property Tax ID - J / ys\\-S\�I'd0a3-006-Cot No.
Site Plan Name:
Project Name: -5W. b 9 C.In 1t3S
Setbacks Front Back: Right Side: Left Side:
_Mechanical
_ Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ -, 2VOI, i`
Name
City:
_ Gas Piping
Zip Code: 3y9$`!P Fax:
Phone No. $6�^ M -- .
E-Mail: /i1eM.e..:ttA,AenGbII. coy-,
_ Sprinklers
—Shutters
_ Generator
Sq. Ft. of First Floor: _
. • L.
/Windows/Doors
Roof Pitch
Utilities: Sewer _Septic, Building Height:
Stater
Fill in fee simple -Title Holder on next page ( if different
from the Owner listed above)
Name:
Company: gyWi uir r a,
Address: /16 SrL
City: Stater
Zip Code: ��^�`� Fax:
Phone No72YQ
E-Mail
State or County LicenseC dlfi Is-/&M
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requlrea.
SU A -ME Al ONSTR
GTIC?N EN LAW I
FORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:=
Address:
Address:
City:
Zip: Phone
State:
`Ctty_l1 .7. State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencinia work or recordine vour Notice of Commencement-
`ll"_
��
Signature of caner/ Lessee/C"o'n�racto�,,rr arQ�n
��
Signatu e o ontractor/License Holder
STATE OF FLORIDA
STATE OF+LORIDA
COUNTY OF P G Yh- V\
COUNTY OF MaYfiV\
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
"day
this2B day of , %,>n 20_L by
this 2,1 of —Nuv,.Q— 2014& by
f P 2=1 1-:i u i i via
(-)o,�-A C_' iQ 4
Oamd of p rson niaking statement.
Name of peison making statement.
Personally Known x OR Produced Identification
Personally Known )� OR Produced Identification
ti�ype of Identification
Type of Identification
rodu�
Produced
ZUNNY RODRIGUEZ
ZUNNY RODRIGUEZ
NOTARYPUSUC
\ ii' NOTARYPUBUC
o�}�,
y�AT= nF FLORIDA
l`F4.oRln
(Signature o N tary Public-Oiflr60GG213453
(Signature of Nofafy Pub 6; G213453
Commission No. CE1IF Expires5/2412022
(Seal)
1d 1W ExpirIM4J2022
Commission No. ea
a�.
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SUPERVISOR
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MANGROVE
COUNTER
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CEIVED
TEMPLETED
[�RE
rev. 0/4/1/