HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: Permit Number:.','- b U1lJU' !
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 ReS,idential _
PERMIT APPLICATION FOR:
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Address: �i�x �� �LJ�- � ��i0 5'' INCE
Legal Description: Y3- tr� 6-' I(— Cele
Property Tax ID#: G 35 - 007 ' Lot No.��
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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COMSTRUCT(DNINFOR,
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Additional 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: $ t a 0 r Utilities: —Sewer _Septic Building Height:
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OUVNER/LESSEE �t n CONTRA
Name
4A, Name:
Address: (✓� lJl - ' Company: /
City: /rbcs CI 62& State: L Address: / Std "%��1A-D0 pl__
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Zip Code: ~Fax: City: � S: L. State: �
Phone No. a - (oa- -2-3 Zip Code: 3 �{2�� Fax:
E-Mail: Phone No (77d) --3L/;)- 9_X3
Fill in fee simple Title Holder on next page (if different E-Mail 9 61
from the Owner listed above) State County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ;
,.
Sl1�PP'LEMENT' L Ca.NSTR+.tJCTI®N LIEN LAUV IN'EaRMAT10N:
DESIGNER/ENGINEER: _Not Icable MORTGAGE CO PANY: N icable
Name: Name:
Address: Address:
City: State: City: State:
Zip: one Zip: Phone.
FEE SIMPLE"TITLE HOLDER: Applicable BONDING COMPANY: Applicable
Name: Name:
Address: Address:
city V 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 thepermit 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 recor our Notice of Commencement.
Signature of Owner/Lessee/Con ractor as Agent for Owner Sign of Con or/License Holder
STATE OF FLORID _ STATE OF FLORIDA
COUNTY OF COUNTY OF 5� �`uC qZ
The forgoing instrume t was ack owledged before me The forgoing instrume 'was ackn/wledged/before me
this d3 f day of 201to by this3; day of u 'l 20/`4-by
6) (-)L a, c ltd
(Name of person ack ledging) (Name of person ackno a ging)
(Signature of Notary P ic'State of Florida) (Signature of Notary Public- t e of Florida )
Personally Known cati Personally Known v OR Produced Identification
"""" JOSE FRESNILLO pe of Identification
Type of Identification ot', yP�ao,,
Produced Notary Public-State of Florida roduced JOSE FRESNILLO r'
+ .• Commission#FF 184850 Notary Public-State of Flo id
��G'l P� MYY Expires Dec 22,2018 ommission No. :• (S69I)mission#IF 18485
Commission No. ��°`'� Bolide t rough National Notary Ass ." '-.,f P.°;� My Comm.Expires Dec 22, 0
'lilt.� Bonded through National Notary ISE i^
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE -. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.