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All APPLICABLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: s 2U Z8 Permit Number:
01T [L C E RECEIVED
NOV 0 5 1010
Building Permit Application
Planningand Development Services Permitting Department
P . Lucie County
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:
Address: a Zrrael J l E/5-3 2
Property Tax ID#: G/�2S —701—e'? `WoG` Lot No.�
Site Plan Name: Block No.
Project Name:
MWy .
/ /x /r IC J o /10/!
000 ' reA cA lar 19/IG c
New Electrical Meter Second Electrical Meter
€ �, "3 �', '�"xi�.''�C`�,'r $'rs,'�" , , Z, e f
CONSTRl3JCTION INFOsRM T1T®N t } "'1 �_
r _ �_
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: /?, 'Acv,� Sq. Ft. of First Floor:
CJ
Cost of Construction: $ �>h` Utilities: _Sewer _Septic Building Height:
.�+--"�S.C' .+•.��e -€� -'� - f a„ z,z t Ak ..r3•Tr �� r-.�: -F� a
OV1/,NtER/LESSEE= -V 21Vt r, ` x CO TRiACTOR � 7 s E ~ } :M
E3ss nrsi4� :za ��r b�ktr o"�w!> tag x ?F rya cTr ��^� r_. _ x�
Name a1�re/ Name:
Address: /SO 12,J Company.
City: State: Address:
Zip Code:�gsZy Fax: City: State:
Phone No. �Q S - c-II&I 7 Zip Code: Fax:
E-Mail: !✓U�P /e,,- 6 C V/ . Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
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.
UPRM'EN A CO;NTR TIO;� LIEN`L�AVI! I`(
DESIGNER/ENGINEER: Not Applicable MORTGA E COMPANY: Not Ap licable
Name: Name: i►��� �-
Address: Address: nn
City: State: City: <x- State:
Zip Phone Zip: 72a Phone: S cl7
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
structure.PleasleCconsult withyoiurHlomeOwnners Association IandrreV ew your deed for any restrict that
which maor
a prohibit such
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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOR DA STATE OF FLORIDA
COUNTY OF S - V-;:� 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 `` day of tJ o J ,2020 by
this day of 12020 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 Notary blic-State of oEANNP`MpAIEGNENs
Signature of Notary Public-State of Florida)
7.J GG 022023 ,
•• MISSION# 2020 mmission No. (Seal)
Commission No. Gas S.Dewmbb UndeN+dl
oP` go ded ThN Nolaty
n
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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