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vvvlmeny jury i KALI UK 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 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 attorney before commencing work or recording our Notice of Commencement.
R
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
N N
M p
STATE OF FLORID STATE OF FLORIDA o c)N
COUNTY OFCOUNTY OF -� . r o 0
N d (S Co
Sworn,to (or affirmed) and subscribed before me of SwoJ� to (or affirmed) and subscribed before m f" "� �`
Physical Pres nce or Online Notarization t/ Physical Prese ce or, Online Notariza o a N W
this -//'day of 20� by this J day of 20� by ?_ a E E
a T E o
�°
Name of person making st e[ri AtJNY M. GUZMAN me of person making statement. z U,
'�.
Notary Public - State o Florida
Personally Known I&MM1 §� Ibr r 3723;
Type of Identification `�� `; My Comm. Expires Oct , 2
Produced t��a� rr•►•,;�,�
(Signatur'eallotary Public- State of Florida )
Commission No. q Z 3-3 (Seal)
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Personally Known OR Produced Identific
Type of Identification
Produced C�
(Signaof Notary Public- State of Florida )
Commission No. ` _� z3_3 (Seal)
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
DESIGNER TNGINEER: ,
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:
nuiurn / - �.�..
vvvlmeny jury i KALI UK 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 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 attorney before commencing work or recording our Notice of Commencement.
R
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
N N
M p
STATE OF FLORID STATE OF FLORIDA o c)N
COUNTY OFCOUNTY OF -� . r o 0
N d (S Co
Sworn,to (or affirmed) and subscribed before me of SwoJ� to (or affirmed) and subscribed before m f" "� �`
Physical Pres nce or Online Notarization t/ Physical Prese ce or, Online Notariza o a N W
this -//'day of 20� by this J day of 20� by ?_ a E E
a T E o
�°
Name of person making st e[ri AtJNY M. GUZMAN me of person making statement. z U,
'�.
Notary Public - State o Florida
Personally Known I&MM1 §� Ibr r 3723;
Type of Identification `�� `; My Comm. Expires Oct , 2
Produced t��a� rr•►•,;�,�
(Signatur'eallotary Public- State of Florida )
Commission No. q Z 3-3 (Seal)
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Personally Known OR Produced Identific
Type of Identification
Produced C�
(Signaof Notary Public- State of Florida )
Commission No. ` _� z3_3 (Seal)
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z/- 2-` Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
-
EsRUI'OSEL� 1tV PROVEMENT LOCATION:
Address:
—r
Property Tax ID #: YQ 0 3 - /S - C) Q - 7 Lot No.
Site Plan Name:
Project Name: 6 i�" '; t
DETAILED DESCRIPTION OF K
New electrical Meter Second Electrical Meter
Block No. / (� Q
�CONSTRUCTICiN INFC►RMATtON: -
Additional work to be performed under this permit- check all that apply: A4
_Mechanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ -,-2 j D U
Sq. Ft. of First Floor: —
Utilities: __Sewer _Septic
OWNER/LESSEE: — -
Name
Address: % 2 U 1 CcJ4 fc 0 5 h L
City: State:%�/
Zip Code: 3 97f2' Fax:
Phone No. 7 7 -?- - 3' .7,2, - (/, 7- y
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height:
CONTRACTOR:
Name: y
Company: �i ct a., �P�C
Address: % f/ j- /Z -a y , is lei _
City: 61-1 C -t State:`
Zip Code: E / l f Fax:
Phone No `7 -7,�2 7 f
E -Mail /'04 r -
State o Count License- f
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.
We hereby propose to furnish the materials and perform the labor necessary for the completion of
150.
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