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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I� �%. Permit Number:
Zr [Lucm
O -
° j` DBuilding 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: 6
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Address: 2IO r•�, cam✓` C-" F.rf Lc,crP ILL 3Y 9
Property Tax ID #: M 000-1 ' 000 Lot No.
Site Plan Name: Block No.
Project Name:
R e n i a c -e , Y i t-f a S e ....1 ci 1 Gi v% CA 6 n C
New Electrical Meter
Second Electrical Meter,
Additional work to be performed under this permit— check all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ SGyT
Sq. Ft. of First Floor:
Windows/Dooes Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
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DOWNER/LSSEEfi��xsrttCONTR�A(q�R.tTr�si��°..,.
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Name SoSht,a po. , in c Q
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Name:
Company:
Address:_/ ?U Rio ,--a e- Cf
Address:
City: Igo �-fi St C 0cl a State: _1�4
Zip Code: 7/Y 9 Y 2 Fax:
Phone No. (' -c f S Y 8 / 3 G a
City: State:
Zip Code: Fax:
Phone No
E-Mail: i c- IQr, nce(8e�� t �. c w.
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
t
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. J 7) S G
DESIGNER/ENGINEER: _ Not App
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone:_
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State: _
Zip: Phone:
BONDING COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Not Applicable
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 Pg jobsite before.the first inspection. If you intend to obtain financing, consult
with YAndpr nr an attarrnev Kefbre commencine work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF -�'t' ,i,
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
P ysical Prewc'Qor Online Notarization
this 'I day of UC�'k 12020 by
Physical Presence or Online Notarization
this day of 2020 by
Name of person making statement'
Name of person making statement.
Person ly Known OR Produced Identification
Personally Known OR Produced Identification
Type o dentification
Type of Identification
Pr d44 A
Produced
natur of Notary Public- to of Florida)
(Signature of Notary Public- State of Florida )
Commission No.
Commission No. (Seal)
_ ___
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/20