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All APPLICABLE(IyN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: &`A� 6113 Permit Number:
E c c L` L Lf 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: era r( I
PROPOSED IMPROVEMENT LOCATION:
�
Address: --Yls� �- My-Iactr�'r
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
A
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
rr,, ? _ Sprinklers _ Generator �oof � 16• Pitch
Total Sq. Ft of Construction: V V0 Sq. Ft. of First Floor:
t
Cost of Construction: $ qz k Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: h \t
Addreessss: Oyl •
CompanyQ� "�
City:56, 2' '(�,zs . L-QQA-C, State:.
Zip Codek -J!Zt i4 Fax:
Phone No.
Address: Q)�
CA A
City:
y
Zip Code:, �[^t—•C()- Fax:
Phone No • 15
State
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail l>n'FO C�61'1CN
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State or County License
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: ate:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE DER: _ Not Applicable
Name:
BONDING COMP _Not Applicable
Name:
Address:
Addres
City:
Ci
Z• . Phone:
Phone:
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 Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conWict 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 followin� building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory st uctures, 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
Signature df Owner/ Less /Co tr or as Agent for Owner Signat re of Contra for/Li en Holder
STATE OFF A \\'' -- STATE OF F ORIDA \ ^
COUNTY OF V�1�. 1 COUNTY IF (lfl@ir
to (r affirmed) and subscribed before me of
hyslcal Presence QQr Online Notarization
i day of 9�r . 2020 by
statement.
Known OR Produced Identification
Type
Sy
grn to (or affirmed) and subscribed before me of
slcal Presence pr_Online Notarization
this n/
ay of 5VX&P li- . 2020 by
on
Name of person making statement
Personally Known `� OR Produced Identification
Type of Identification
igna ure of No ry Public S �- J WAN1ANEGRON B ignature of N ary Public- stat -ida) movANNAI"
MY COMMISSd1
MY COMMISSION I GG 323420 IRE AM
Commissio i No. d'. QpQ,yM ' (SeA)ws: Apo ie, 2on Commission No.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED