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All APPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date
IF
Permit Number
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, fort Pierce FL 3x982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR0
:
Commercial
Residentia
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Address:
Property Tax ID #:
Site Plan Name:
Project Name:
141
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Additional work to be performed
Mechanical
Electric
Total Sq -0
under this permit — check a
Gas Tank
_Plumbing
Ft of Construction:
_Gas Piping
_Sprinklers
II that apply:
Shutters
Generator
Sq. Ft,, of First Floor
Windows/Doors
Pond
Roof Pitch
SEENEWEEMENE16
Cost of Construction: 00 is,. Sewer Sept*lc Bui'ldwing Heig t"
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Name 11P !a A, /J I PLCM Names.
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State Addressq,: km
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Z910 Code: oo 0 Fax. C16 t Y State
Phone
E-Mail:
Fill in fee simple Title Holder on next page
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Zip Code:
Phone No
E -Mail
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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 I*S $7,500 or more, a RECORDED Notice of Commencement is required.
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Not Appliocable MORTGAGE COMPANY119 Not Appl'icable
DESIGN ER/ENGIN EERO dmmpnwv��
Names. Na el
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C'18 ty: state.* C 41 ty': State.
Z 0 a Phone:
16 Phone
Zip#
IPIN
N Not Applicable
FEE SIMPLE TITLE HOLDER* Not App14'
icable
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Name. -
Na
Ad d ress.
Address.
City: cit y
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P h o n e zip@
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to f4 obtainpermit
I I indicated.
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OWNER/ CONTRACTOR AFFIDVITO, Application Is hereby made to
to ou L"c wv, a"
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I r-prt']'fv that no work or installation has commenced prior to the issuance of a perm*lt-P
4holder to bUfla r
ine suojeu buytow, c
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presenLatt
ji a ii�� ts that may resiri EA u r P, u �I L JU%O
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DID cable Home wners i
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St. Lucie County makes no red
which i s in conflict with a ny a
.,�n a�rthorize the permit
structure., Please consult �thyour Home Owners Association ana re��eW yvul ���� •�• -••, �----
Inconsideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
_ �__ __� �. e..,..e r,,...,+v Ampndmpnts.,
in accordance with the approved plans, the Florida suiiaing c.oaes ana ��. ���1_ �V�•, .••-••-•••----
.. rnnm 71ifi1tlAflS.
The following building permit applications are exempt from undergoing a cull concurreriuy 1�vic•v. ��..��-•-•-••-.
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 pU blic records of St.
Lucie County and posted on the j*obs'te before the first you intend10 f Commencementto obtain gp consult
with lender or an attorney betore commencin
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VLMOMW 1�e
Smgnature of Owner/ Lessee/Contractor as Agent for
Owner
WU[ K U 1 Cl.ul uI"
Signature of Contractor/ license momer
STATE OF FLORID STATE OF FLORID
COUNTY OF
LgetLz COUNTY OF
Swornto (oraffirmed) and subscribed before me of
00fi sical Pres c or Online Notarization�
thi day of
Name of person making statement.
Personally Known OR Produced Identification �
Type of identificaX�.Qr�
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5�6R
CC)MMISSIOn No. 1 � — lopm
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Sworn to (or affirmed)
to�p�t $[Cal Presena
this �`6 day of 1
and subscribed before me of
or Online Notadzatlon-9
f , 2020 by
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L. �i S filolG�✓�
Name of person making statement.
Is
Personally Known OR Produced Identification �
Type of Ident"i ic
Produc EREPENEI C>
_
V-
-'F- of Notary Public;
Notary Public Stale o F�i�m� •,,,, Nn
Lasa B Motherway
;� My Commission GG 75858
ExotreS 0411 2 /2 0 2 4
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�. Notary pubbC State of F10rW%
Us�@�I�ttien�vay
My Commission GG 975858
EKprrs 2=24
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