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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: qq AYE MAR 18 ?.0% Building Permit.Application pERN1ITTING Planning and Development Services Bt. Lucie county,FL Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X PERMIT APPLICATION FOR: �fl�ti��= ���• 10111 PI_'NAA N L©CA iO � ` �/ Address: 'bf3 01N- t IAVl�-C= `� vtk " R Legal Description: PropertyTax lD#: � z,2- �Q j' ��d rt�QO "� Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DE�SCR{1PTION dF WORK: `Zc= t` 1'�v�c-lam m cam` COSTR+UCTIO INF©RI\/f TION: itlona I work to be pertormed under this 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: $ qL490 96 Utilities: —Sewer —Septic Building Height: .y;iac-.i?sm,iti'sr�C.4��a:•..,._.y9+c••;%nvx:'`ir��.': �meu,,,�: p,' `C:=` L City: A e' L State: )E7/— Add'(' 'ss: )Ll q SVJ 3 Zip Code: 3 G Fax: City: `?O fl:� �9(t�E State:. L Phone No Y l Zip Code: Fax: E-Mail: Phone No ,�- 3 . Fill in fee simple Title Holder on next page(if different E-Mail ` ' r"o- A, tAOv- oc�rn 'from the Owner listed above) State or County License (2-)kc if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENT L CON'STRl1CTION LIEN L,g1N I' 'FOR+fUIMM ONS : 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 commencing work or recording our Notice of Commencement. Signature of er/Lei_see/4kent Signature of C-ontraNE44ee.Xse Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF S_' �Q LU'0 The forgoing instrument was acknowledged before me The for oing instrument w s acknowledged before me this day of 20_ by this day of / 204 by (Name of person acknowledging) (Name of perso a nowledging) (Signature of Notary Public-State of Florida ) (Signature of Nota ic- ate of Florida) Personally Known Personally Known R r,�d IdentitI08Ei SNILLO Moo,Type of Identificatio �•o"s'r°�e�; JOSE FRESNILLO Type of Identification a` Notary Pdblic-State of FI ;a �; Notary Public-State of Florida ,• Commission M FF 1NS50 Produced Produced (salon#�FF 184850 y'Comm.Expires Dec 22.'2018 •�;,OF F��� My Com Expires Dec 22,2018 Notary. Commission No. �'t BondedthlonalN�aryAssn. Commission No. N�tloRas REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.7/2014 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: ,TNot-Applicable Name: Name! Address: Address: City: city- Z71 p: ity:Zip: Phone: _ Zip; Phone: OWNER/CONTRACTQR AfFiDV1T:Application is hereby made to obtain a permit to do the•work an.0-installation as indicated. 1 certify that no work orinstailati'qn.Fias,,o umancad prfor,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 Owners structure.Please consult with your Home 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 uridergoing a full concurrency,review:room additions, accessory structures,swimming pools,fences,walls,signs;screen roams and accessory uses to another non-resident6f6se WARNING TO OWNER;Your failura°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 er/Lessee ent Signature of.Contra se Halder STATE OF.FLORIDA t STATE Of-FLORIDA e COUNTY OF_ 1u COUNTY OF S' i' I !r.fn The forgpingmstlrumentAas ack wledged before.me The fo oir)g instrument w ack�n Wedged before me this .4day of :z0 :by is, day 4f 20 by' 10, (Name of person ackil ging) (Name of perso a nowledging) (Signature of Notary Pub c- to of Florida j (Signature of Nota c- to of Florida.) Personally Known .. Personally Known . .. a enti lbgt�. ld Type ofldentifitiltio' TyQeof'tddntifitation : NgIMY'Pilbllt:'�IllartfatJMitl Produced X riibl{r:`�8lu�dt :10 claim *"o FF f 90 rocedtat#FFt118aDalt a� . Comcission No. Commission No: AwL REVIEWS FRONT ZONING SUPERVIS0.11 PLANS VEGETATIQN. SEA TURTLE -.-MANGROVE COUNTER . :REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE -COMPLETED