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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: i J C Permit Numbe :
DECEIVE®
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Building Permit Application OCT o zo20
Planning and DevelopmentServices
Building and Code Regulation Division Commercial Res i sn&d .ie Coin
Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462;-1553 Fax: (772)462-1578
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PEWIT APPLICATION FOR: /��/p(/� (� \/)y�r�)f'
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Address: L1L100. Crfa�lt<<"6- tst PNCNk-- �,. `iI�:s`° - �'� ( a
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Property Tax ID#: a-`�a�' Sd�- ada��bad -rp II Lot No.
Site Plan Name: 1 Block No.
Project Name:
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�:4} 'i���`.� �v���. $4."7.'�}'.k�':.� ...5"a.^�.��'. v:�3��`�"�^�'�s�»�.�;'�P�m +''.,e.# r,.�r'N�_.a.- Pr"$!,,4!Fit;� a 'FY's�,i�dnr�_�!:..�x. .r� .:.x,..':�a�.a o '�.�.A• .kms �'fr
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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
_Electric —Plumbing —Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ (� co Utilities: —Sewer —Septic Building Height:
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Name �1s L.a �� ')i� Name:
Address: ve-1(,ct P; P,\J1'-R U, Company:,
City: lkber V P(CState: d" Address:
Zip Code: uat4.L-) Fax: City: 1: State:
Phone No. tb li Lt Zip Code: Fax:
E-Mail: (fisc(, 01CCC0101_ �{�G(��G�I 'COM Phone No
Fill.in fee simple Title Holder on next page ( if different E-Mail I
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$1,500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: 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:
OWNER/CONTRACTOR AF.FIDVIT: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:rhust be Tecorded in the public,records of St.
Lucie ounty'and posted on the jobsite before the first inspection: If you intend to obtain financing, consult
with le�clpror an attorney before commencing work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA �i STATE OF FLORIDA
COUNTY OF ' SA— UAQA C- 1(�41J COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this CD day of Ot,� 20aj� by this day of 20_ by
Name.of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR.Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Nota: Public-State of Florida vdSignature of Notary Public-State of Florida)
NA�iEGNENS (Seal)
Commission No.Cr�a ""'•, (S�D�
:,�,• Sr'•: My-�dMMISSION#GG 022023 ommission No.
sr, 4 . EXPIRES:December 16.2020
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REVIEWS FRONT SUPERVISOR ` PLANS ' VEGETATION SEA TURTLE MANGROVE .
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
T-e—v—. 5/6/20