HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4 ---er (6-/ Permit Number: I `Ii (T./ (►,, 7
co u IN r RECEIVED
IF L O R ! U Ft
r Building Permit Application ppR 09 1019
Planning and Development Servicespepartmcnt
Building and Code Regulation Division PerSYtt�nu ie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT TYPE:
PROPOSED UMPROVEMENT`LOCATIONa
Address: 19/0/ j 77L £ hall& foRst P�fILCE PL. 34(91'2-
/ /
Property Tax ID#: 062. -- 4OJ - oto - oo%f Lot No.0 i '/z.of IQ
Site Plan Name: Block No. /1
Project Name:
•
MAILEDDESCRIPTION OF WC)IRK? t
js1579[.. AO Nou4 chit. -raopt c.. 7/15' (//Z, gTU.$) lifxrpuMP
Did ExL377A)4 d09b IJi7i1 c /c- $EaV/ice- ( SJNoe Fag
CO: STRUCTIONFORMATIONo
Additional work to beperformed under this permit—check all that apply:
_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: $ .3 7 7 C9 • Utilities: _Sewer Septic Building Height:
®W @R/LE—S@ tl° ^, CONTRACTOR? .
Name 4fi111y 4 3O C�IIFPITt1 Name: QOQC C./ 3,A,.. oo)y 7?
Address: (SO/ / IIT' !�I ilos Company: P/n✓c./ /? YEA/AI J-
City: Fo2v f lame State: Fa Address: $948 5. 61.5 /IAJy I
Zip Code: 3402. Fax: City: Ara- Sr. Lucie" State: ICG
Phone No. 172 302_ 4-7y? Zip Code: 35V9S2. Fax:
E-Mail: 2--- eWit .._. ilj Live. coiv., Phone No 777 33 J--- 7`4S
Fill in fee simple Title Holder on next page (if different E-Mail JTO2c Z'5' P 151RX1II,IT44✓y tpM
from the Owner listed above) State or County License LSCC /3//s z/Sly
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
ROPPLEMENTCA,CONSTRUCTION E1 UM INFC7RMA ICHE
DESIGNER/ENGINEER: _ X Not Applicable MORTGAGE COMPANY: )( • Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: X Not Applicable
Name: Name: if.,-
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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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, imall 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITHVYOUR ENDER OR AN ATTORNEY"BEFORE RECORDING YO OTICE OF C MMENCEMENT" -
Signature of Owner/Lessee/Contractor for Owner Signature of Contractor/Licen e.Hol . .
1
STATE OF FLORIDA c STATE OF FLORIDA -4,
ci L VC`
COUNTY . COUNTY OF 77
OF UGI
The f. .in instrun t,wa acknowled before me
The rgoing instrum �y ,s a fknowledg ctefore me this ' is .ay of f�C • ,20 by
this ay of + 20 J' by
eockc-f--
s Ei C )u,clw00/)7 jA_-_
C . b u Y W O O D y in...._ Name of person making statement.
Name of person making statement.
Personally Known , OR Prod 1 entJ'fi tion/ •
Personally Known OR,Produced Identification Type of Ide • ii: ;on P-...• ed 1C1 c (tel ce�// _,
Type of Identific. '9
r ��zzpp /1"Produced � lf' lJ"h /
1#4 . ' I / (Signature o NotaryPublic-State of Florida )
(Signa of re of N.—a v o � --. - Commission No.
"-<, MICHAEL McHALE e °c, MICHAEL cHALE
Commission Nb. •
:-N.,,,,,,;,,,
. MYCOMMISSI 168796 o MY COMMISSION#GG168796
P P EXPIRES:December 17,_021
v,. E RES:December�7 2021 � o
'C'OF FSO . OFFS
REVIEWS FRONT ' ZONING . '• 'SUPERVISOR PLANS" VEGETATION!. SE4 TURTLE MANGROVE
. COUNTER REVIEW . REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19