HomeMy WebLinkAboutBuilding Permit Applicationi_
All APPLICABLE INFO
/MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /V Permit Number:
I
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: 0 s�1 --h ctf
PROPOSED IMPROVEMENT LOCATION.
Address: (0104 Vucccr Lam' - . F+, CA . -�3 9 9a
Property Tax ID #: JY Op - 10 j c) — E�(o o� j — 6(L�Jr Lot No. W
Site Plan Name: 1 Block No.
V q
Project Name: of- (1 e KQ I GLY/► -cz
DETAILED DESCRIPTION OF WORK:
R-0VC\C_VQ7N—tincCkC,fL
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters )(Windows/Doors
Aectric Plumbing _Sprinklers _Generator Roof Pitch
(7 Total Sq. Ft of Construction: ,00 Sq. Ft. of First Floor: / C%s�o
Cost of Construction: $ ��� % Ca Utilities: _ Sewer )L Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name geu49r\+Caro(e
dr (udt
Name: 42ro ba Iis
Address: S30o SuviGei'RIVd.
Company:, rYl Qy Drr1le.Si LLC
City:, 2/4' iP tc-Q State: fL-
Zip Code: -3c{9ga Fax:
Phone No. %'701- 3 -3— 1tf 3 3
Address: 3 �,_����Qc,4 awj.,�.r_0ei�
City:Ll3l� ,",o,s State: -a,
Zip Code: 33 y I p Fax:
Phone No
E-Mail: CgW4r WzU9). mli
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
Q r>rlt°GJ t Playi»m2+ �.
State or County License CP�G 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:
DESIGN7EEERRRr/ENGINEER:
Name:l'0�i �!allL04hre
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address: I 91ch6rd
Ln .
Address:
City: PGQM SO Av5
Zip: It Woo Ph ne
Stater
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
/Not Applicable
BONDING COMPANY:
Name:
,,Aot Applicable
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 6f Owner/ Lessee/Contractor as Agent for Owner
SignatuM of Contractor/License Holder
STATE OF FLOj{�'LjDA
STATE OF FLORI A "
�0
COUNTY OF VCJ e-. akd-,,
COUNTY C
The forgoing instrument was ac nowledged before me
The foor�going instrument was acknowledged before me
3 JO�r%�.20�by
this�dayof b�I`� 20q by
this dayof f
Q 1�av-*15
�PVlln Dav�3
Nam& of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known / ' OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
gnature of
DEANNE L. JOHNS N
(Signatui t ic- e )
r "AYJNE L. JOASON
..n
Commission N MY COMMISSION 0G_%g1§1�
Commiss "�" �, MY COMMISSION#GG251845 Seal)
EXPI :July 17,"`220211
, 2021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19