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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c�D C7 Permit Numb
-19 (01:2)X -
FEB 2 4 2020
Building Permit Application
Planning and Development Services Permitting D ei'p,::i r .i"E'i e n t
Building and Code Regulation Division, 5t. Lucie Cou i7-yi FL
2300 Virginia Avenue,Fort Pierce FL 34982 —
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
PROP(3- ED IM�PRO E7MENT LO ION:
Address: I
Property Tax ID#: �� 1 a��� – ��P ����–� Lot No.
Site Plan Name: Block No.
-Project Name:
DETAILED DE S-0 RIPTION O WOR
CON TMUCTI N INFORMA ION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
O NEM/L-5- "M N'
Name aT Name:
Address: \to etQNI
City: c Stater_ Address`:`:.:,?+,,
Zip Code: S49 Jr I Fax: City: l - State:
Phone No. Slo i– S O2)--5tQ01`o ZigR:
:.
Co'de: :..,.: „ . Fax:
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E-Mail:�c.c)Ornw �
c � Ci-C\,-\ �- '� � e.0 1. Phone No t
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County 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.
19-IN
PLEMENTAL ONNSTRUCTION LIEN LAIN I'N 'URMATION:
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 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 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
POS D-owir E JOB SITE BEFO HE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
ITH 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 ;'A STATE OF FLORIDA
COUNTY OF ,f��LC/ COUNTY OF
The ff ling instru er�t was acknowledged before me The forgoing instrument was acknowledged before me
this day of �� 20�0 by this day of 20_ by
l� n EC
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Iden ation Type of Identification
Produced Produced
(Signature of Nota_ -Yu bhc- tU (Signature of Notary Public-State of Florida)
v:s ,, AUDREY S.HUMPHREY
Commission No. C414IMII�eft1#r,�,300817 Commission No. (Seal)
Pte: EXPIRES:March 6,2023
:1jF., .•OP.:
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.