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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED'
Dater d ! I� Permit Number:
RECEIVED
• �
Building Permit Applicati n SEP 2 6 2019
Planning and Development Services ST. Lucie 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:
-P.ROPO"SED IMPROVEMENT LOCATION'
Address: 2-101 k,f 6Jr.s RD
Property Tax ID#: G 1 d ( y D - 000 - ' F
Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK
(� I I;q,C C Ux<c CA res' car c
V� q_0 co fie- ' 3-/l C-( Ll��� ��. 6 L) f e4S
CONSTRUCTION°INFORMATION: ;
Additional work to be performed under this permit-check all-that apply:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
'f Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ( , (} 7 7 . a 0 Utilities: —Sewer .Septic ,Building Height::
OWNER LESSEE
CONTRACTOR u
Name �lW` 'OrC� " C! 'wN��n; r' Name: !`i
Address: Company
CitState: Address:
Zip Code: 34 "T Fax: City: j�r'� �re1�c a State: �`_
L
Phone No. Zip Code: '�Cl Li ' Fax: 7 !:7
E-Mail: Phone No 7��`LI 6 C - 03-00
Fill in fee simple Title Holder on next page(if different E-Mail W 11'c1U 1-Z /1G(VC�01 , (XIN't
from the Owner listed above) State or County License
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.
SU;PPLEMENTAL:CONST.RUCTION. 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 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR L NDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA �. STATE OF FLORIDA
COUNTY OF •C-yc` COUNTY OF
The for__gpp�!ng instrument as acknowledged before me The forgoing instrument was acknowledged before me
this 2 if--bay of 20 L�by this?�ftday of T 20f� by
Name of person making statement. Name of person making statement.
Personally P c I e t' ! ion. Personally Known ✓ OR Produced Identification
Type of Ide ^= Type of
Produced ,� I� a dt F!otida q �. •.,•tI- n
Produce
9Wd5rhM@019bG 185665 Chris L Woolley ° pride
N,pftrol"W22. 65Gi 5 My Commission GG 14505 _5
r s 16 022 7 Expires 02/`6/2022 .2 566
(Signature of Notary Public-State of Florida) (Signature of otary Publit--ftat'9W r!
Commission No. G� l5r/565— (Seal) Commission No. G6I$T46s-- (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS- VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 9