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Home My WebLink AboutBUILDING PERMIT APPLICATIONAPPLICABLE INFO MUST BE COMPLEi cu-FOR APPLICATION TO BE.ACCEPTED ate: Y' '� SCANNED Permit Number:. tA 0,57— BY Building Permit Application , Planning and Development Services Buildind and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 / Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial bl Residential PERMIT\TYPE: Address: Property Tax ID Site Plan Name: Project Name:_ c-) � V\ Lot No. c.scS� �C� C) Block No. Additional work to be perform Mechanical G — — 1 — Electric — P Total Sq. Ft of Construction: Cost of Construction: $ !d under this permit- check all that apply: s Tank —Gas Piping —Shutters bing —Sprinklers —Generator Sq. Ft. of First Floor: &o Utilities: —Sewer _Septic Windows/Doors Roof Pitch Building Height: OUi/NER/LESSEE \ n CANTRACTOR Name 1. S I cL,-% c` L�\CLS i' Cu1tr/C1 11Sy Name: ,-` A— �� Addressa5�(} 5 ��1 Company: ca ,,--, �� City v� S2v� 'l%ewc�%\\ Statel--L Addres 3 (-cJ li'�-c, �a Zip Code: �j4 S Fax: �� City: oc(, v►I- C l l�Y State: F Phone No' c' - y � G -- Ce) / Zip Code: 3 V- 59 C� Fax: 77a - ��6 -3271 E-mail- �- S L• 1 �t S J ic'.` `fit L ` C�'� Phone No l-1 a - a - via �C� Fill in fee simple Title Holder on next page (if different E-Mail !�- (/Vl Oc.) 4 A6 c) from the Owner listed above) State or County License CPC. If value of construction is $2500 or more, a RELU`RUED Notice oT Lommencement is requireu. If value of HVAC is $7,500 or more, a RECORDED1Votice of Commencement is required. SUPR!_EMENTAL CQNSTRU' IO I:IEN IAUV INI ORMATION� $ �r _• m,... �. _.... m ,. 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 recor ed and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with le er or an attorney before commencine work or recording vour Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF I"\ try Tfie forgoing instrument was acknowledged before me T. The forgoing instrument. was acknowledged before me day of , 20_ by thisr 11lfhday of Mot V , 20 1, °( by ., ia dilI a of person making statement. Name of person making statement. V P`ers�onally Known OR Produced Identification Personally Known OR Produced Identification ype of Identification Type of Identification Produced Produced S7 r VP rS L-% CCh SP (Signature of Notary Public- State of Florida) (Signature of Notary Public- State f F o ida ) Commission No. (Seal) 1 -1 t�aYnv'' BEN DEPALMO Commission No. 3 l :�� .., 4taryPublk-State ofFl it rf Commisslon N GG 1931 „,' My Comm. Expires Mar 7, n t rang National ota REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA L COUNTER REVIEW REVIEW REVIEW REVI"EW REVIEW REVIEW i DATE RECEIVED DATE COMPLETED P1/ i i SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: ii DESIGNER/ENGINEER: _ Not Applicable I MORTGAGE COMPANY: Not Applicable, Name: ; _ Name: Address: Address: j City: State: ;City: State: Zip: Phone i Zip: Phone: 3 i FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable Name: Name: Address: Address: i 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. l6rtify, 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 Association st ,ucture. Please consult with your Home Owners 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. Thy 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 "dY RNING 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 J BEFORE THE FIRST INSPECTION. IF YOU INTEN TO OBTAIN FINANCING, CONSULT WITH YOUR �N' 1_ O N ATTORNEY BEFORE RECORDING Yq TICE F�COMMENCEMENT.- Sig" atu of Owner) Lessee/Contractor as Agent for Owner Signature of Con ractor/License Holder STATE OF FLORIDA STATE OF FLORIDA, COUNTY OF %�2 COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me thisday of C , 20L� by this )5- day of K ( 20�1 by Q-f'.11�.. _ — Nam of person making statement. Name of person making statement. Personally Known Personally Known OR Produced Identification Cle— Type f Identificati n ,';Ypi?,; JENNIFERLYINGLiNG P = �. . __ Notary•Public -State of Florida Type of Identification Produced ommission9GG073870 Produced My Comm.Expires Mat 26,2021 20 emdedihrau cnalNataryksr. SUSAN SLACK Notary Public -State of R r1 III Commission P GG 3013 2 i ur, of otary u ic- 5 too FI rida (Signature of Notary Public- Stat o • VfMv6a YAy Comm. Expires Mar , 0 IIBond d through National Notary AJI Commission No. Seal) Commission NOQ- 7--mJ (Seal) REVIE S FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE..... _____.._.._.._. I ____._. ... - ......... ._ RECEIVfffD DATE I COMPLETED Rev. 2/7/19