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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� 2
Date: 6/6/2019 Permit Number:
SCANNED
BY
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St. Lucie County R�CEiV�p
Building Permit Application JUN 06 2019
Planning and Development Services I
Building and Code Regulation Division ST. Lucie County, Permitting
2300Virginia Avenue,. Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT TYPE: Demolition
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Address:
Property Tax ID #:
Site Plan Name:
Project Name: St Lucie County Central Serv./Adminlstration
Demolition of Steel
Additional work to be performed under this permit— check all that apply:
_Mechanical
_ Electric
_ Gas Tank
—Plumbing
Total Sq. Ft of Construction:
Cost of Construction:$ 2,400.00
_ Gas Piping
_Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor: _
Utilities: _Sewer _Septic
Lot No.
Block No.
Windows/Doors
Roof Pitch
Building Height:
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OR
Name St Lucie County Central Serv./Administration
Name: Cheryl A Jacquin
Address: 3071 Oleander Ave.
Company: P&C Construction of the Treasure Coast, LLC
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone No, 772-216-0168
Address: P.O. Box 4343
City: Fort Pierce State: FL
Zip Code: 34948 Fax: 72-461-0095
Phone No 772-216-8900
E-Mail: mastersb@stlucieco.org
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail occonstructiontc(abaol.com
State or County License CGC 056649
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.
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DESIGNER/ENGINEER:
X Not Applicable
MORTGAGE COMPANY:
X Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
X Not Applicable
BONDING COMPANY:
X Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby madeto 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 Counttyy makes no representation that is granting a permit will authorize.the permit holder to build the subject structure
which .isin conflicr 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
warm YnuR LFNDFR OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
/
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Signature of Owner/ Less
ractor as Agent for Owner
Signature of Contract ense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF St Lucie
COUNTY OF St Lucie
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 6 day of June
2019 by
this 6 day of June 20_12 by
Name of personmaking statement.
Name of person making statement.
Personally Known X OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Produced
VZTA
/I Z-\
Produced
/ \ /\
O!`� j �y, ��c State of Flonda
(Signature of Notary Pu ic- of SEIDIM
Commission No. —` lr
GG 188140MyCommissionGG169740
22/2022
(Signature of Notary Public- S t
Q (� /�..s+Ny Notary Public State of Flonda
Commission Na.U'"t ia9_ 't.tlersion
Expires 02/2212022
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COMPLETED
Rev. 2/7/19