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All APPLICABLE 1,4170 MUST BE COW �c i ED FOR APPLICATION TO -BE ACCEPTEDti
Date: �ZC� PermitNumber:; ':.���.
r AUG 2 6 2020
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Building Permit Applicati n
Planning and Development Services ) y FL
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Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772Y462-1578
PERM IT APPLICATION FOR:
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Address: 7,42
Property Tax ID #: -I 1 5 f Lot No.L4
Site Plan Name:kvic YW .00 ,-T L L{ Block No.
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Project Name: D�(� CC
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New electrical Meter Second Electrical Meter
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Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank — Gas Piping — Shutters _ Windows/Doors _ Pond
,ktectricPlumbing -Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: --I C) Sq. Ft. of First Floor:
Cost of Construction: $ `E iwo . oc> Utilities: SeviieP�-_Septicu,,:,;. Biu'tldi;Bg;H fight:
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Name Name:
Address: ``ZLlb'.V' Company: ? �Ih k*X
.
City: Pe� L State.r-L- Address: 411 1 NS j
Zip Code: -3-kCJC7-2 Fax: City: !�L— Stater
Phone No. Zip Code: i�-1nv"i? Fax:
E-Mail: Phone.No
Fill in fee simple Title Holder on next page ( if different E-Mail Cgc
from -the Owner listed above) State or County License_
If value of construction is 2s00 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: N pplic' ble MORTGAGE COMPANY: _ Not licable
v - App•s
Name: Name:
Address: Address.
City.
State: City: State
• Phone -
Zip: one
FEE SIM TITLE HOLDER: _ Not Ap le BONDING COMPA _Not Appli e
Na Name:
dress: Address:
City: City:
Zip:
Phon Phone:
OWNER/ CONT OR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I'certifythat no work orinstallation has commenced pronto the issuance of a permitp l ,
St. Lucie County makes no representation that is granting a permit will abt�aws or and co a ants that may restrictorprohibit such
which is in conflict with any applicable Home Owners Association rules, y
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 m 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. Ifyou intend to obtain:fmancing, consult
with lender organ attorney before commencing work or recording your Notice of Commencement_
as AgenTforQwner I Signature of C o /Lide_5older
STATE OF FLORIDA,
STATE OF FLORIDA (1
COUNTY OF
COUNTY.OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Online Notarization
Physical Presence or Online Notarization
20 b
Physical Presence or
this Wda'y of 20�� by
This day of y
rr
I, S
Name of rson ma i tatement.
Name of pe so ' making sta a t. ,
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identi i ation
Type of Identification
Produced
Produced D LI
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(Signature otary Public- St't4u_-__•__
(Signatu�of�aryi�lic- State of Florida )
AUDREYB.HUMPHREY
f pb 3008'1'l�p�' t�P.•
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Commission No.
; <.••. •• DREYB.H � Y
Commission No :_° MUILSSIO(a4)
; March 6, 023
* '*` EXPIRES: 2
=* :*: MY COMMISSION#GG300817
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