HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' �(` l '� Permit Number:RI -
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Building PermitAppl Nov -7 2019
Planning and Development Services
Building and Code Regulation Division tting Department
2300 Virginia Avenue,Fort Pierce FL 34982 u I @ county, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial____.________
PERMITTYPE:
PROPOSED'IMRROVEMENT-LOCATION;
Address: -s ( O
Property Tax ID#: o Y C i J oz I - C) I D Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:-
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ORK M eiL eS� C(„n (�a cnna(n� ss. S4 erv�
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_(Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
V Electric _Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �. 3 2 d U o Utilities: —Sewer —Septic Building Height:
SINNER/LESSEE CONTRACTOR ;
:.
11.
Name 0 CPM C-C b-6 `4-S Cy - d T 1(-, Name: N`U- L-4-ovrrcfaLk
Address: S f O I"'`Q H-'0?�,Vrck\/ Company:. \nf=_0`UC l %" M L
,City: State: Address:, 6 4`.;. ". � PairaC� Ny
Zip Code:' . Fax: 7 7 Z- �1 GG -.c�709 City: o/�-:. Pane..: State: �[;
Phone No. 7 '2 ' `6"LI W 7
Zip Code: .����` Fax:
E-Mail: -1-Pitc,a�,�k � a_UCCM x'615_ c0-0?� Phone No' 7?2 - CI CC- &J-co
Fill in fee simple Title Holder on next page(if different E-Mail ffico I ,CoIM
from the Owner listed above) State or County License r L 1 3 U G SS I
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 COM ENCEMENT."
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Li ense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �� �J� COUNTY OF ��,
The forgoing instr ent wa acknowledged before me The forgoing instr4r�ent w acknowledged before me
this�day of 20�,by this A_day of YV Q 20 ft by
Name of person making statement. Name of person making statement.
Personally Known vsOR Produced Identification Personally Known_1../ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of No ry Public-Stat f Wo a
�� Notary Public State of F or�Wgn ure of No"P;ublic- fit rld8latary Public State of Floride
Chris L Woolley Chris L Woolley
Commission No. lily � ���✓ ��t alryCo missi zozz 18 s0m sion No. ��^�I?` t� d02126/2022 185665
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.