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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number. v_�
91Y. [LUC �
Building Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial Residential 1/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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PR�OPOSED3'IIVIPROVEME�NT LOCATIONr ,'
_ o« -s ,L s. « a a k�xsce ax 7�3:.
Address: O �f �IOI�j' O '� �,
Property Tax ID#: 14S I I 00 1 a— a®o 3 Lot No.
Site Plan Name: &je�.4cw- Cw i3 Q0L_0LJJ Block No. i
Project Name:
' , a NC 7y+ k ri w
DETAILE-D�DESCRIPTION �F
New Electrical Meter Second Electrical Meter
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CONST&RUCTION INFORMATIClNr53� "' �`
A@tt- e d d`:v e x:*r,> N 1,+ 2. .K`.•;� C��t ,'�s',v_�Z ..u, 1.Y.
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric _Plumbing _Sprinklers -Gen erator f/ Roof Pitch
Total S . Ft of Construction: t % S . Ft. of First Floor:
G q �7
` ` 1
Cost of Construction: $ 1Q4060 Utilities: —Sewer —Septic Building Height: ` �e
OWNER%L ,55E h CONTRACTOR
Name I �IJ Se- 5 Name:
Address:_0+ 4AS o(_XS i_ Company: 9l�-t/Lli;-
City: ''rs 83F� State:FL— Address:_ 59.O_Ct SW MNR-K-E L SD
Zip Code: NISI I Fax: City: IPA'L—t--k C'1'`1 State: FL_
Phone No. Zip Code: Fax:
E-Mail: Phone No 71,R — —54 9 —a2.7 3S
Fill in fee simple Title Holder on next page(if different E-Mail 5:;UYWVW0Q�DjL9b ,
from the Owner listed above) State or County License CCC Y 302 61 95-
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.
ISUPPL`EMENTAL CONSTRUCTION LIEN LAW IN"FORIVIATI�;N
. -
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: Stater
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 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 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 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
with lender or an attorney before commencing work or recording our Notice of Commencement.
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Signature of er/Lessee/ ntracto as Agent for Owner Signature of tractor/License Nolder,
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ��-� COUNTY OF S l—
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Phy sical Presence or Online Notarization Ph- 'cal Presence or Online Notarization
this day of Q��O 2020 by this ay of 2020 by
Name of person maki6g s atement Name of person makin atement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification ��� Type of Identification
Produced - Produced
(Signature o - (Signature of -
ELLEN VAUGHN L HN
�11111/// ;1D�y pU�
p1PAY p`/B!, - ;_� ��-state of Florida
-Notary Public
Commission ox �c fate of Florida Nqt I ublic Commission N - Commission # q� Jpo79
-* *= ommission # Gt 2 �079
oa My Commission Expires
e my Commission Expires October 22, 2022 .
REVIEWS FRONT 1` ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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