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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:15 Permit Number: I` RECEIVED DEC 112015 _ Building Permit Application 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 Residential PERMIT APPLICATION FOR: L PROPOSED INP ©UEMEN LOCAT 4N: Address: 3So3Ave I C I q-7, Legal Description: - Property Tax ID#: L/ (�5r ®j'' 0�z5 / 000"Jr' Lot No. Site Plan Name: Block No. Project Name: " Setbacks Front Back: Right Side: Left Side: DETAILED DE�SCR+ PTI©N OF WORK: CONS TRUCTION INFORMATION: Additional work to be pertormed under this permit-check all that appy: Mechanical —Gas Tank —Gas Piping _Shutters _Windows%Doo`rs _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: .10Cost of Construction:$��oo — Utilities: —Sewer _Septic Building Height: • �:1 �� 1r . , All ` Nam , ,/{IA.�'�a.?� ame ddress'.=�' J' ` a-i ��.P-c c bmp'any ic2C6 State: d`drss �✓ f Y:,1 CA' Zip Code: -30 1 q2. Fax: City:C State: Phone No. Zip Code: Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page(if different- E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUP LE E L.CONST 11�T10 Lk.l T W 11; !.W®R�MATION.: 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: 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 commencingwork or ecordin our Notice of Commencement. Signature of Own es ee/Agent Signature of ractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forggoing instrument was acknowledged before me The for oing instrument was acknowledged before me this /y day of Dec-,5?inn 60e l�y this �' day of @-4_-M G ALO + y JaV�F i -O VC P. (Name of person-acknowledging) (Name of perso ack ledging) (Signat e f N ry Public-State of Florida) (Signature o Nota Public-State of Florida) Personally Known QR.Pr Personally Known Type of Identification .`•4 �p`e,,, JOSE FRESNILLOType of Identification ,,••49p`y,,; JOSE FRESNILLO Produced ::° `� Notary Public-State of Produced r+4 `8; Notary Public-State of Florld8 •. ,•? Commission�FF 18 •. .•? ommlaaion#E FF 184850 Commission No. '%s+ o-c� My Cor�rAy fres Dec 2J2,201 9, o:= My Co� Irea Dec 22,2018 BondedtfuoughNatlonalNotCommission No. sn��uo¢• BOndedtf�OU�analNotary Am REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED _F R 7/2014 ev.