HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEI10 7016
to
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:
WO � eco 0-
PROPOSED I PROUEME�NT L®CATION:
Address: 'Q Ce :3 7 r<qe
Legal Descri- 1
Property Tax ID#: 1 �/ r 70 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
qO UAIJOA P-IC646L [-33CA�- � eCAA-e�
CONST-aUC I0` FO A ION:
itiona wor to a pe orme un er t is permit-c ec a tat appy:
Mechanical _Gas Tank _Gas Piping _Shutters. _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First.Floor:
Cost of Construction:$ S00 Utilities: Sewer _Septic Building Height:
OWN /LE�S�SEE: C®NTR 0
Na. et" tlG�'SW \ QP%fe t Name:,
Ad reds �nSb�:rr�.' ':.per,ue= Company " dot i
City G, 1-G✓► ;- :.r;C�:. _ State:r— Addre :� /� i
Zip Code: 33cf Z Fax: City:
l2iiL State:
Phone No. 777 ` 33 3a Zip Code: ��` l Fax:
E-Mail: Phone No 5 '15 05-6
Fill in fee simple Title Holder on next page (if different E-Mail '
from the Owner listed above) State or County License
value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
5,UPPLEMENTAL CONSTRUCTI®N LfEI\I LAW INF®:RMATION:
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 re rded a•d posted on the jobsite
before the first inspection. If you intend to obtain financing, consult wit lender on attorney before
commencing work or recording our Notice of Commencement. JJ
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contracl<License Holder
STATE OF FLORIDA STATE OF FMA
COUNTY OF 1—�c \ -, COUNTY OF^�� C .
i
The forgoing instr mm
e t was acknowledged before me The o going instrent was acknowledg before me
this�day of a� 20��o by this day of cfYlY � 20� by
Y%C'\ 4—Y1-e_ �C�STLO'S
(Name of person acknowledging) (Name of per cknowledging)
(Signature of Notary P ,bjc-State of Florida) (Si re of Notary P)jblic-State o Flor:Dla)
Personally Known :OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification .• °""°"`
Produced L L- N�tEeNEa�o23 Produced BERSNpRODRIGUEZ
.? pF.1dt 1GN C'C' 2020 i° •1'B�••: mycom ISSION#GG 01219
c 5 �,...,, �tgS m�r16, erNnte� ommission No a <€ ($e8V1RES:July17 20 rs
Commission No: - 1 6 Qere� `«una e:Sonde'3ThN Pu6t�
..• Notary
.N: ,�i goaded
REVIEWS FRONT ING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014