HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I )OR— 0 )�0 1
EIVED
Building Permit Application
DEC 261
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: Z � I L�L
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PRa '�9 SED INPPRQ IM, NT LOCATuo,I77
ON
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Address: W0 � UQ� � —Fol--rt 4c--xLSC. r�- -
Legal Description:
Property Tax I D#: � QQ&—) Lot No.
Site Plan Name: Block No.
Project Name:SU h►-�;� od,, ,Y�72� d�1�•
Setbacks Front Back: Right Side: Left Side:
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A itiona wor to a per orme un er t 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: $ 6 Utilities: —Sewer .'_.Septic Building Height:
,µ�„.e:: ,�V,.:� r=* ti a - , 7 *5^ "-"4 �I w
LES" 4l, 4, ,� "+;t " �i �I" i N F$ 5 ni 1�
OWN. R° LESS^EE �y - CtJN1'RACTOR. „, � FiY4
p � =
(f� ^�� ss;'.F'�rr �, sa .c ..;
Name &lq A11 tlou iS• Y'L/ �ZJ 5-- Name:. /dam.
Address: //��3 S, � AAv'w4 � iJ� � Company: C�f/7�1-R1.A
City: P294, — S lya2-6` State: F. Address: /Y S%[� 1ZVV7V4) 6 .C..
Zip Code: 2 5:15 Fax: City: �. S� State:
Phone No. Zip Code: ���(�� Fax:
E-Mail: Phone No 99/3
Fill in fee simple Title Holder on next page ( if different E-Mail Yd.�a✓��o !n' , C
from the Owner listed above) State or County License_ C
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
rifil"! eQ_NS-fRUrCRiI®N LIEN I.�W INDRIh/IAT101�:
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 Owner/Lessee/ r ctor as Agent for Owner Signature of Con ractor/Lice Holder
STATE OF FLORIDA,,,/
STATE OF FLORIDA /
COUNTY OF /f�CZ COUNTY OF
The forgoing instrupnent was a knowledged before me The forgoing instr ent was acknowledged before me
this day of /� �=/n�E A .20 1-6 by this_R day of ✓ 14/ 20--16 by
(Name of perso acknowledging) (Name of pe n acknowledging)
(Signature of Nota. P li - a e o FI ria (Signature of N tart'`Public- ate of Florida)
R�P , JOSE FRESNILLO ,++++��+�,,, JOSE FRESNILLO
Personally Known ;�`" `'�o4$tl19 1dN1 0tibQ09i6frF Personally Known �,c tiaf�f bjj&� �4�of FInrida
Type of Identification =•o' Commission#FF 184850 Type of Identification ;• .° Commission#FF 184850
Produced '%'9; `�;� My Comm.Expires Dec 22,2018 Produced -.° "oma: Comm.Expires Dec 22,2018
F.++ Bonded through National Notary Assn. °' °;;°`� Bonded through National Notary Assn.
Commission No. R ea
Commission No.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
COMPLETED
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