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ALL 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
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:,(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Y
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Legal Description: '5AUAfWA -:�LLIQ ._fiLA7` Ung- -11C 1 - L0iH (b;K /,S6'2- 3169:22-M-1-010)
Property Tax ID#:��Yd S, -- 'rM- 01 OV-DL>S_ ii Lot No.�_
(Site Plan Name: Block No.
Project Name:A
Setbacks Front Back: Right Side: Left Side:
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Additionalwork to be nertormed uncler this permit-check all t=appy:
HVAC Gas Tank []Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof �� Roof pitch
Total Sq. Ft of Construction: S .Ft.of First Floor:
;Cost of Construction:$ (l aW Utilities: Sewer Septic Building Height:
q,.. ::.r•+..- "'+ $u't"•� ;� 4q," vY.A - '0S c. {' 1 •�Y y r E '• '�F �r
Ifa i JJ %�c � ca'y�
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Namei'YIZC61 �C. !d 017��? Name: ��1)
Address: ?I 9 AUC'KT}fDk10 2VZC6C Company: OPWOP 5 kWE/V_ 0 _,Ti0z,)Fr
city: -Pokr ST Luai-_- Stater Address: //moo/ 5e S:' /Ur�177ee/e% e%�zcle
Zip Code: 3 V CS a Fax: City: ObiI1-S"i LU CTS State: F•l-
Phone No: -77D-6,96- 0230.? Zip Code: 300— Fax: `97d-335 9550
E-Mail: lb. I-magi 6014 Phone No. '77.;,'-- 3 3� R55p
Fill in fee simple Title Holder on next page(if different E-Mail: b ,i LJ &6yhT1ft R(1U� arr-
from the Owner listed above) State or County License: (10(t 6 Sas/3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.1:
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SLIRPUE, ENTAL CONSTRUCTION LIEN; YUV INFORMATION rT i 4 � "'U'. �3
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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: 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.
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 thepermit;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 anyirestrictions 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.
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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�,resuIt 1n'your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or;an attorney before
commencing work or,-recording our Notice of Commencement.
signature of Ownerf i-essee/Contfactor as Ag ery for Owner Signature of Contractor/Lit>eHolder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF 57- LGc COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�day of_ IJTMQ 2 , 20 !P by' this-rday of 7f111bPoo 20__W by
Name of person making statement Name of person making statement
Personally Known --�'_OR Produced Identification Personally Known V-11, OR Produced Identification
Type of Identification Type of Identification
Produced Produced--.1kyp". v00 _
* *MY COMMISSION#GG 077376
` °9F DENISE 1:51Wfo�`o� 1 .
WIRES:March Z3,2021 "
(Signature o Notary Public-State,` , o MYCOMMISSION#GG077 745ignature of Notary Public-State o Florida)
*
Commission No. dn,7 3,1 , al) PIRES:March23,202 .0 mmission No. (Seal)
OF P1�Q Bonded Thru Budget Notary
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW ' REVIEW REVIEW REVIEW ! REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17