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All APPLICABLE INFO MUST BE COMPLETED FOR
Date: 2,0
APPLICATION TO BE ACCEPTED
Permit Number:
COUNTY
F L O R I D A«i 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 ! X
PERMITTYPE: UM.-hcr ktaster
PROPOSED IMPROVEMENT LOCATION:
Address: <^ZZO ljJtnht}0<^L<Xnt
Property Tax ID #: fitftcl \t> - SSZ7'm'00t3'O(iO'7 Lot No. 7S
Site Plan Name: ftp ZOA Af^^^rve. PtthU (VgUe Rnrf
Project Name: Vjddrv ^.^otWrWoi^
Block No.. 3?7Z7S
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical Gas Tank Gas Piping Shutters
Electric _X Plumbing Sprinklers Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ I 200^
Windows/Doors
Roof Pitch
Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
;rw«jr\ Name
Address: ^^220 ijJty&vOo<Vnlyy.
Name: 3ameA VVAVaWigW
City: Por^ Sr.^M^t^ State: £L..
Zip Code: Fax:,
Phone No. SlO'S^O'^Wl
E-Mail:
Company: fr«.fc flou)f\viLrwip\v\ SeY\<\Cfc^"X*nc.
Address: 23*?3 Su) TyJor^ IS^.
City: Pof-V St-.Luci., State: fL.
Zip Code; _J^3^ Fax: 772-^75-77/7
Fill In fee simple Title Holder on next page {if different
from the Owner listed above)
Phone No 772- ^77-72,77
E-Mail jvm^-PFpVuyn^o.Com.
State or County License CPC 1427^25
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.
SUPPLEMENTAL CONSTRUaiON LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address: Address:
Citv: State: Citv: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address: Address:
Citv: Citv:
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."
Signaturjwjf Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF SF.Uxcie.
The forgoing instrument was acknowledged before me
this 2D^dav of , 202O by
3wgs WoVVoAxmqlv
Name of person making st3iement.
OR Produced Identification^ Personally Known X
Type of Identification
Produced BRENOA R. DECARA
(S^^^. Notary Public-State of Ron flf' }d
Commission RGG 310775
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Sf.LuLcig
The forgoing instrument was acknowledged before me
this ZJ? day of F^x'X ^ 20 20 by
Name of person making statement.
Personally Known X OR Produced Identification
TTpe of Identification
uced
My Comm. Expires Jul 1, 20t3
floraeb ttiroujh National Notary A sr.
(Signature of Notary Public- State of Florida }
Commission No. 66 3ID775 (Seal)
BREND4 R. DECARA
Notary Public • Slate of Flonda
^J^Jfyg/ Commission #GG 310775
'••-Torrv^' My Comm. Expires Jul i, 20^3
Sortleb through National Notary As n
(Signature of Notary Public- State of Florida )
Commission No. 663f0775 (Seal)
REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19