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A!! APPLI LE IN � 8E CQMPLETED Ff1R APPtiCAT101� TO BE ACCEPTEDDate:
Permit Number:
LL uLma_- —
LL"
Planning and DeveloAmentServices building Permit Application
Building and Code Regulation Division
Z300Vlrg►nlaAvenue, Fort Pierce Ft34982 Commercial ----- Residential
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT�.� �r1C�
LOCATION:
Address: —7 14, 0�r^ v - , i
Property Tax ID #: 3 .. O
Site Plan Name: Lot No, q-
Project Name: Block No,
DETAILED DESCRIPTIO------------------
N OF WORK:
New Electrical Meter. Second Electrical Meter
CONSTRUCTION INFORMATION.
Additional work to be performed under this permit- check all that apply.
Mechanical — Gas Tank ^ Gas Piping — Shutters
Windows/Doors � pond
,Electric Plumbing _Sprinklers `Generator
._, Roof __� pitch
Total Sq. Ft of Construction:
Sq. Ft, of First Floor:
Cost of Construction: $_40_7T771 Utilities- —Sewer —Septic Building Heleht:
OWNER/JESSEE:
CONTRACTOR
�1� Name:
AddressW-S
i Company,
City:C State: Address:
�
'Zip CodFax• City
Phone Na.
Zip Code: �-
E-Mail: Phone No 7-70,
Fill in fee simple Title Holder on next page ( if different E-Mail S$ '�-
from the Owner listed abovel ----,
State or County License
if value of construction is ZSW 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.
Fax:
State:r—L
ri
Name: Not Applicable
Address:
City:
Zip: -----�.phoi7e State:
PEE SIMPLE TITLE HOLDER:
Name: -.-, Not Applicable
Address:
City:
zip:...... --....' Phone
OWNER/ CONTRACTORAFFIDVIT:
i certify that no wort; orinst ! Appiicatlan is hereb
IruKMAT10N- r,.
MORTGAGE COMpANV:
Name: -.._ Not Applicable
Address:
City:
Zip: ---- . phone: State: �,
BONDING COMPANir:
Name: —Not Applicable
Address:
City. -
Zip: Phone:
a lation has com Y made to obtain a permit to do the work and in as indicated.
5t. Lucie Coen p commenced prior to the issuance of a permit.
makes no it representation that is ranting a permit will authorize the permit holder to build the s
which is In con ict withMakes an a
structure. Please consult withpp Ii�aylQrs Home Owners Association rules, bylaws Droop covenants that may restrict orprnf�ihitsuch
In consideration of the granting of this requested Association and review your deed for any restrictions which ma btect structure
in accordance with the approued plans, the Florida, Building CodeI do and gr Lune Count Mayapply.
hereby agree that i will, in all respects, perform the worts
The fallowing ct building permit applications are exempt from undergoing a full ie C u nty' A renew:
accesso Y Amendments.
con
rY structures, swimming pools, fences, walls, signs, screen rooms and accessory uses another non -reside '
4NARp}il�p�'T� �7WfVER: Y room additions,
IPr1�lroVernent to yQ failure to Record a Notice ofCo ntlaiuse
Lurie COun a , p operty. A Notice of Cornmen emen�munt may rests
with lender r a P ed n the jobsite before the first inspectio . if au Yd nd paYin� twice for
e re in the public records of St.
orne beforecommencin work or recordin yorill �f obtain financing, consult
Signature of ner/ Lessee Counr or a Agent far Owner
STATE OF L RIDIA
COUP is tip. l 1 !1•� lr
S n to ( rmed) and subscribed before me of
si rese r Online Notarization
this day of
aozo by
-der r�
Name of person making statement.
Personally Known----,2L OR Produced Identification
Type of Identification
tzognsture of IVotar Public- State of
Commission NO,`'''
+ ,. ��
REViEW5 FRONT
�.�---�
COUNTER � RFV.1.#l�d � � lsolr
'story Se`'•`
Signature
STATE
Sworn toLj
Rof,
irm ed) and subscribed before me of
P
esence or online Notarization
th s
2020 by
Name of person making statement.
Personally Known OR Produced lde t! cation
Type of identification
Produced
( Ign ure Notallotis
:ommission No. Kart PuhfzeSta3ar
1(arf R�Ip,�,- �'de
1
e°flP4 967938
VEGETATION JS!EATUlj� £-
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