HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 r �g. Permit Number:
L}. .n� RECEIVED
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- - Building Permit ApplicalrionSEP 6 2Qi9Planning and Development Services cle County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT TYPE:
-PROPOSED NPROVEMENTLOCATION
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_ Address: S S E e_s4w 0 GT
Property Tax ID#: 1 11 SJ o C5 - 0 U ' b Lot No.
Site Plan Name: Block No.
Project Name:
..DETAILED DESCRIPTION OF WORK.
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"CONSTRUCT 'N INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
JElectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ I �0 00 Utilities: —Sewer _Septic Building,Height:
OWNER/LESSEE h"� - � :CONTRACTOR ' '
Name �1V I Il� M _S''1 e���r� r�1' fv Name: CN. Lr : urA, <
Address: 86 s -s C Fee-.iH_vo, ,6bLtf f- Company: Ad!n '—(l (�4(_'
City: ?6(`4- S4- L Ut fe State:FL- Address: 25 014 �-OA�40 Q C,- VC
Zip Code: r 1 Fax: City: r f l- Q;u'c-d State: FL
Phone No. Zip Code: 314 g U, 7 Fax- "772 -9 6
E-Mail: Phone No I72 - L4 t� C J-UO
Fill in fee simple Title Holder on next page(if different E-Mail W"t\&w�Z "/z-C (; ko l . cwn
from the Owner listed above) State or County License G I% O U S.S -7
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA ,�� STATE OF FLORIDA
COUNTY OF ,C COUNTY OF � 4X
The forgping instrs acknowledged before me The forgoing Instrume t wa acknowledged before me
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this day of u en wa20 X1 by this.
�ay of 20A by
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Name of person making statement. Name of person making statement.
Personally Known V OR Produced Identification Personally Known _ OR Produced Identification
Type of Identifica Type of Identification
Produced Produced
taq�pay Mate of Florida Notary u is a of Florida
Chris L Woolley Chris L Woolley
My Commission GG 185865 My Commission GG 185665
�w wd� Expires 02/28!2022 C a^ Expires 02/2612022
(Signature of gotary Public-State of Ion (Signature of IMULdl y ub ic- tate 61 r1driud
Commission No. &6-t`6S7664'_ (Seal) Commission No. GG i8 S6Gf (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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