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All APPLICABLE INFO MUST. BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - Permit Number: Z)— s (a Ls,
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V,ICOUNT
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Building Permit App I icatiorAY 2020
Planning and Development Services
Building and Code Regulation Division ,
ent
2300 Virginia Avenue, Fort Pierce FL 34982 �@ i' f"I I Cj_i I i 7; ; a `� 6^t.I i
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Res' d6ritiil County, DFL
PERMITTYP.E:. i , 1.1U00 W
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Address: i&Qn �
Property Tax ID#: I o4 -6®y Lot No.
Site Plan Name: Block No. .
Project, Name:
Additional work to be performed under this permit —check all that apply:
_Mechanical Gas Tank —Gas Piping _ Shutters WindowsJDoors
Electric - Plumbing _ Sprinklers _ Generator _ Roof',, Pitch
Total•Sq. Ft of Construction: U Sq. Ft. of First Floor:
Cost of Construction: $ p (p,. Utilities: _ Sewer _'Septic Building Height:
S@JE:
CONTRA T •'R•
Name � ,o � 1v� ��l 14
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Name: -
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Address: 5Z 7 I Sq Iefie /Ar1-e—
'Company:
Address:
City:• a State:1::�L
Zip Code: J qq(fo Fax:
Phone No. 7 i Jr% g 9 qO 9
E-Mail:
City; ,.. 1! ..::' ...... ; 1State:
Zip Code: Fax:
Phone, No- - -
Fill in fee.simple Title Holder on next page ( if different .
from the Owner listed above)
E-Mail . .
State or County License
IIIf 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.
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 th'e 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:'-�,J&n
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ev.
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_'Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Sig ture of Owner/Lessee%Contractor as Agent for Owner "
Signature of Contractor/License Holder '
STATE OF FLORIDA
STATE OF FLORIDA ,
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of, ,26�by
this day of , 20_ by
� d'n i J I GL ra
,� .
Na person making statement.
Name of person making statement.
Pe ovally Known OR Produced'Identification
Personally Known OR Produced Identification
Type of Identification^' •'
Type of Identification
_
Produced (%1 % 1 �' •
Produced
(Signature of Notary ublic- State of Florida)
(Signature of Notary Public- State of Florida.)
Commission No. •""YP�••, AUDREY, .