HomeMy WebLinkAboutBuilding Permit APP GroothouseAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
`-
° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: �L LOG C
Address: 7 7) U 0 1 V \Y-4 v 1 1�<- V- c.a ??
Property TaxlD#: 3(_JG3- 2)(C)o,l—GOo-� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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C'J S� �I�� InSiakt r�ws� V4� rc��i�
New Electrical Meter Second Electrical Meter (Affidavit required)
INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator X Roof Pitch
Total Sq. Ft of Construction: 3(0 C)0 Sq. Ft. of First Floor: -3<a O 0
Cost of Construction: $ 1 0 I OOy Utilities: —Sewer Septic Building Height: 1
OWNER/LESSEE:
CONTRACTOR:
Name—Vhq
I W l 11G ti
Name:
1016
o �t6
Address: )0 V 1 l `e [2C11.
Company: 0 } f C)
CAI ) ii-
City: C'of-- P\ -e r ciz State: �L
Zip Code: 7J Lf ti Z- Fax:
Phone No. E-
Address: q 33 S 1\0 I'-e V
City: '06 1 r V1 C l i
Zip Code: 3L( qq Cj
Phone No :1% Z S
i State: ✓L
Fax:
2�i I. O-7q
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 14 a �0� d (P
c+Ho } u I l � LLB
State or County License
�mom,
(C(— 12)D- -7 SJ`)
IIIf value of construction is 2500 or more, a RECORDED Notice or commencement is requireo. II
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
C-fi-'t v`<uti S-r-
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to 0o the worK ano mscauauon as muumiea.
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 conflicts with anj applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 paying twice for
improvements to your property: A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
;.6 1e "r ^r nn nH,,n.phafnrc rnmmpnrino work nr rprordine vour Notice of Commencement.
Si re of Contracto - or - Owner Builder as applicable
STATE OF FLORIDA I C
S-1�
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this W" tlayof-kAk\ucly l 2022-by
—
00fC"ld Otto
Name of person making statement.
Personally Known l`�/ OR Produced Identification
Typ Identification Produced
Z'A&" LiZ
(Signature of Notary Public- State of Florida)
NANCY INAGER► ORST
' } P F Col S
Commission No. al)
Notary Public
VNE
State of Florida
Comma HH16M2
E N
Ewkes 23
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21