HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4 Permit Number: ' IQ� (J ]LOG
SC NNFD
S4:V udeCount'VBuilding
=E91—V
Permit ApplicationPlanning
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 X
PERMIT TYPE:
PROPOSED IMPROVEMENT
ow
ON:
Address: 6 00 1A P ( /pf C
Property Tax ID#: I'in Ira() �)02Z3_0002) Lot No.
_
Site Plan Name: Block No.
Project Name:
D AILED DE�CR PTION OF WORK.
CONSTRUCTION NFOR ATION.
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _szlwindows/Doors
_ Electric _.Plumbing _ Sprinklers _ Generator _ Roof - Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ I() • OM Utilities: _Sewer _ Septic Building Height:
OWNERjLESS -E.
CO TRACTO
Name — u —
Name: JA^ LL 'l"JQ
Address: w✓a�c, 1Ltw PC%IvIC
Company: C o`'6 T. C
City:, -ire; " ' ��cr,(—.';;--
?;i State: 1�//
Address: fj5kLf0 -S -- t- W4
City: cy, r -State: C C �
Zip Code: 3(A'9 r 1 Fax: , •'- -.l
Phone No. -, 2 zlr. - SE�g-a
Zip Code: 3u q (A 7 Fax: )`l�'G7ZS3 1 6
E-Mail: S:- -IG' t.-c4-
Phone No -•--- =.:.. -'"'
Fill in fee simple Title Holder on next page (if different
E-Mail A cisl t n0 (R) GMa. PO.M
from the Owner listed above)
r—
State or Count License
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.
LASJb 4S4D @�ah�n• rim '
w�)
UPPLEM =N A CONSTRUCTION W
NFO
ATION•
DESIGNER/ENGINEER:
Name:.
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Add�ess:'
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
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 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
�YIMPR/OVEMENTS TO YJOB SITE OOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED WITH YOL{{I EZN R OR AN ATTdRNEY BEFORE RECORDING YOUR NOTICE OE.COMMWIYEMENTTHE FIRST INSPECTION. IF YOU INTEND TO OBTAIP NCING, CONSULT
-)y &&& *10
1 X& Ni
Signat re of Owner/ Lessee/Contractor as Agent for Owner
Signa a of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
4,
COUNTY OF �llC I�
COUNTY OF (
The rgoing instr men was acknowledge efore me
The fir oing instrme was acknowledgenefore-me
t1his1 day of 20 by
C1=�1P�V l ��.�5
this day of \t , 1� . 20� by
��•7��C
Name of person making statement.
Name f person�comaking statement.
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identi ' 'on
Type of Identificati
Produced L
Produced L
r
(Signature of Nota Public -State of Florida)
(Signature of Notary Public- State of Florida )
Commission cco "" '. KAREN S. IyI
loritla- tN1no Public
°"""" KAREN S(3d6�LSEN
Commission No. .�•.•^'•s'',
tar
r YY
y •5 Commission # GG 2074B4
,`^--StaTc of Florida -Notary Public
y a Commission
P`:
# GG 207484
"^""°
June 12, 2022
'�.,,a�(;°.o`
isswn
J 2
Expires JA
REVIEWS
VISOR
PLANS
VEG
2 VE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
Ib
DATE
COMPLETED
Rev. t/ i119