HomeMy WebLinkAboutCCE_000093 permit app.All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
Commercial
Residential
PERMIT TYPE: /Gr�,./X7G�
PROPOSED IMPROVEMENT LOCATION:
Address: Wvo LR- rceo-fYI
Property Tax ID q: — - D v - 1- Lot No.
Site Plan Name: ( 1�l .P f7tiYl (h $ \ I rUc5lock No.
Project Name: I_X_e r2 1
CONSTRUCTION INFORMATION: l
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
t,--E-lectric _ Plumbing _ Sprinklers _ Generator T Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ �,, , S.25— D 0
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OW N ERAESSE E:
CONTRACTOR:
Nam / S
Name: G'�n
_
Address:- l � L� - I c-�e_a4il1
p9,�
Company: k�
City: �a ✓LSC:. Z�C1Ujl State: EL
Zip Code:, -9)49S4- Fax:.9?9-aay-ZP�a7
Phone No.
Address:
City: Ltlieva ko-Cl, State:P�
Zip Code: Fax: LS -6 ( h6 c -o236s
Phone No �og9 )-i✓�O S14
E -Mail: PCL✓6lr2 •Ohs._ izpMoci(-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail Q,QAAe 'c-cs„"Cly
State or County License CE 13 Oo
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:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
COUNTY OF �a4( "[..
Address:
The forgoing instrument was acknowledged before me
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
2C Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Type ofldentificat' ^;Comm9sm1GG1G7391
Address:
:
Produced iyea4eeeTEe•12 2021
City:
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City:
(Signature of Notary Public- State of Florida )
Zip: Phone:
Commission No. (Seal)
Zip: Phone:
FRONT
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 contylict 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:"
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Signature of Own ei essee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OFFLORIgpkT�
STATE OF FLORIDA
COUNTY OF yy'' lM �L C�
COUNTY OF �a4( "[..
The f Ding instru ent was acknowledged before me
The forgoing instrument was acknowledged before me
th%is� day of T 20.2�by
this day of 20;20 by
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l Je-C7X�Q.F � (� /�CC-
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�T�'p_e _ (�)• -ice'
Name ot6e0on making statement.
Name of p r n making statement.
Personally Known •}:�r:K(38 IGWMtttlNElaIN011Nl11l�10MP
Personally Known, 9
F'.
Type ofldentificatio ., Co^ms;bn1001671W
Type ofldentificat' ^;Comm9sm1GG1G7391
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Produced iyea4eeeTEe•12 2021
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... BixWOTAru Tmy F: iS.�•�yn, WM-31677
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (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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