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!'"�APPUCABLE/INFO MUST BE COMP ED FOR APPLICATION TO BE ACCEPTED ?
Date: / Permit Number:
RXEIVED
s OCT'O 5 1010
Building Permit Application Permitting Department
Planning and Development Services
Building St.!Lode County
ilding and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: a�
PROPOSED IMPROVEMENT LOCATION:
Address: -1VC, 1�.
Pro perty Tax ID#: C)�- -lpOLo — O« - Coo- Lot No.
Site Plan Name: Block No.
Pr jest Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
I
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 _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: 7 Sq. Ft. of First Floor:
Cost of Construction:$ lflqz dv Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
(Name O Name: (r�
Addres= O Company: r C
City: t State: Address:l:S5;_')0 rCGr\AQ_ AV_t_ _
IZip Code:34ci S�— Fax: City:�k Q�p_r�� State: F
0
Phone No. Zip Code: 'Sl(9 Lu s- Fax:
E-Mail: Phone No - cm
Fill in fee simple Title Holder on next page(if different E-Mailj'�e •
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$7,500 or more,a RECORDED Notice of Commencement is required.
l
SI PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name:' 7- Name:
Address: Address:
City: _r Sta e: FC— City: State:
Zip: 1-'/ 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. �ucie 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 Iccordance 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,
acc6 ssory 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 pos ed the jobsite before the first inspection. If you intend to obtain financing, consult
with lenddr r an a . or before commencingwork or recordingour Notice of Commencement.
CSign'atu`re of"Owner LesS"'--- as-, gent for Owrner Signa ure of Contractor/License Holder
STATE OF FLORID STATE OF FLO!
COUNTY OF n �� �1� � .Q_ COUNTY OF .>� . �_[�C��
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or to(or affirmed)and subscribed before me of Swor (or affirmed)and subscribed,before me of
hysical Presence or Online Notarization �— ysical Presence or Online Notarization
is day of ( D r—.2020 by this day of 2020 by
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ame of person making statement Name of person making statement.
personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identificaboh
Produced Produced
.fir+ Notary Public State of Florida
blic State of Pion
JSignat-ure-`6f Notary,Publi a�_ �Im1Si�8�misawn G Si natufe�{Nota blic-Sta df l a anyel Jones
M1 ° Expires 07/0412023 ( g ry �y commission GG 35201
CW Commission No. Commission No. Corr► ' Expires07/0412023
ON
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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