HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INFO /US BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Permit Number:
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:
PROPOSED INPROUEMENT LOCATIQN:
Address: O (j l/ C-L-)/L� % v �.
Legal Description:
Property Tax ID#: ® d� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
(3ETAILED DE�S'CRbIPTION t�F V1F®RK
1114A C2c U 0 le-0 he 2
C®NSl'R<UCT'IO.N IiNfORaMAT'I®N:
56_�&'e-
Additional work to be pertormed unclert is permit—check all that appy:
>�'_Mechanical _Gas Tank —Gas Piping —Shutters _Windows/Doors
—Electric Plumbing —Sprinklers Generator _Roof
Total Sq ,Ft,of Construction:, . . Sq Ft of First Floor:
• Cost of Construction. $ ,:' . ,q0 0 Utilities Sewer' Septic :Building Height:
OWN°ER�E�SSE�E: - CONTRACT®R:
n
Name (n ;"/A1 Name: O ri
Address: v �vE � Company: /�cc `��
City: i�:d7 2T f) State: • Address:
Zip Code: 3 Fax: City: State: /'-2
Phone No. Z_ s-11-Ag-40 . Zip Code: ,3 S S--7 Fax:
E-Mail: Phone No -7 S /
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County Licensee—Ac- SSS`S'a-
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
WPLEMENTAL CONSTRUCTION LIEN LAW INFORM TION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Nbf 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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/ ractor as-Agent-for Owner Signature of.Contr /Li ense Holder
STATE OF FLORIDAJJ � STATE OF FLORIDA .
COUNTY OF Sf�i/JT_ l�Cr L COUNTY OF J/A��r✓j �'�C-t o
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this-Lq day of v.u_-_vv 20� by this_l y day of 20J_< by
(Name of person cknowledging) (Name of person acknowledging)
JOSE FRESNILLO ,,auun,, JOSE FRESNILLO
��ot►A oe%% l :�srav Pu®�:% -State of Flo Id
(Signature of No ry Public itWida ommission#FF 184850 ( ignature of No lic- i3t Qla)Commission#FF 18485
kW-.06V My Comm.Expires Dec 22,2 18 ;s ' Z My Comm.Expires Dec 22. 0
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Personally Known RMPPRed$6gh_'tifi@�aMional Notary srp rsonally Known � O Pr'r1adib �d Id'entificat i�Vatiuoat Notary
Type of Identification pe of identification
Produced s 1,AC LGo Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/201.4