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All APPLICABLE
� 1INFO MUST
BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Num
ST. LUCIE
COU FV`T'Y �,
Building Permit Applic;
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
2Q0- O(Al
JUN 2 29 2020
Permitting &partment
idettia�l 'r �.:..., FL
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PERMIT APPLICATION FOR: t!�6'Yr� �p 4.;A 7 Lon I- &-r; B �
Address:
Property Tax ID q:
Site Plan Name:
Project Name: 0
4
New Electrical Meter Second Electrical Meter
a
Lot No.
Block No.
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Ga's Tank _ Gas Piping _Shutters _ Windows%Doors _ Pond
_Electric _Plumbing _Sprinklers Generator ,Rod, Pitich
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:,$(500 D� Utilities: _Sewer _Septic Building Height:
O NER/LES3E-E.
COT OR:
Name {�Il�l
Nam e:-•-.. '""
Address:
Company: ''
City: State: _
Zip Code2J (o 0 i Fax:
Phone No. - -
Addr'ess:
City:, . "State:_
Zip Code: Fax:
No
E-Mailr
6-V)0tN0.,Phone
Fill in fee simple Title Holder on next page ( if differente-
from the Owner listed above)
Mail
State or County License
If value of construction is 2500.or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
.,, .:
OWNER/ CONTRACTOR AFFIDVITt Application is hereby�inade fo otitaim,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 reviewyour 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencine work or recordine vour Notice of Commencement.
Signal re of Owner/ Lessee/Contractor asAgent for Owner
Signature of Contractor/License Holder
STATE OF PtORMW }, �j e_
STATE OF FLORIDA
COUNTY OF �
COUNTY OF.
Swore to (or affirmed) and subscribed before me of
✓Physical
Sworn to (or affirmed) and subscribed before me of
Pres ce or Online Notarization
Physical Presence or Online Notarization
this day of 2020 by
ennc r 1iirnh
this _ day of 2020 by
Name of person making staement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced fl ` Mh
.I'
Produced
(Signature of
t -
(Signature of Notary Public- State of Florida )
; .''n'.e,• AUDREYB.HUMPH REY
,
Commission No.
- 0MMISSJ6R#IbG300817
Commission No. (Seal)
EXPIRES: March 6, 2023
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