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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Ja (� `_ `_
Date: Permit Number: C -01`��
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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
PERMITTYPE:
PROPOSED 1MRROVE ENT LOCATION:
Address: 761 Aw�FTA Z5-r
Property Tax ID #: �� • � ow 9 • �
Site Plan Name:
Project Name:
Additional work to be performed under this permit - check all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator'
Total Sq. Ft of Construction:
Cost of Construction: $ 100
,
I
Sq. Ft. of First Floor: _
Utilities: _ Sewer _ Septic
t1
Lot No._
Block No.
Windows/Doors
Roof Pitch
Building Height:
OWNER/LE=SS W
CONTRACTOR:
Name A16,s1-Ar Za+y6,rgone -rr5
Name: 6--Al-i0 TV-"VVF-5
Address: IR 11 Ntr 17 2 S-+' :;
».Company::--- 6087ro'
d .. State: -Fe
Zip Fax. '';
Phonq:N'o; ...7 jz._ ;9 7 Y ! 72 �/
;gyres Z iv;lk 67C U
Aticlress.:", ,;75 �., . Sw
City TbKT 6T'= lvc-sue State: �L
Zip:.Gode:--310.Fax:
Phone No 77-C q85 31 64
E-Mail:--- :r_...:::.::- --:
Fill in fee!simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Qbs-ro Ada tic. (2b.QHA;11-
State or County License CAC- 19/'7b''y
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.
PANNIER,RN AL CON TR
CTION L1�E19LAW I
Ft MATI�N;
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY: Not Applicable
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 RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF %� �y�
i
COUNTY OF_,�,
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20_ by
AL J26�t, En q Lz,-)
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification �'
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
J__VQ
(i at re of Notary Publ' -
ignature of Notary Public -State of o�icl
;.•"• ?LAS NA INGRAM•RAHMING
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:*; MY ISSION # GG 275060
Commission No. 3
ommission No. NA g RA90 HMING
: oYPL : ' LASHAH Qom.
IRE : December'20, 2022
t.: ;, Y COMMISSION # GG 275060
"f" • Bonded Tiuu Notary Public Uodemiws
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'•.,OF P �„
Bonded Thru Notary P
brit Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGET3rmI
.COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/ 19