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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: oZa' c� Permit Number: V
o L u I E_ --- -_—
Building Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34932
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Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR: W 7-�A Fl— 1—L C.
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Address: 5 00 Y it 1
PropertyTax lD#: i 3D1 Lo 1 C))'-lR 0oo • I— Lot No.
Site Plan Name: L-aIt_•f'W DOCA P(1_Cl(_= Block No.1114
Project Name: W,)44 FL L-C,
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New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit—check all th t apply:
_Mechanical _Gas Tank _Gas Piping Shutters V Windows/Doors _Pond
(lectric Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: 1 O 0 3 Sq. Ft. of First Flo r: ) p1 "L lQ
Cost of Construction:$ � _ Z Z �'. co Utilities: _Sewer Septic Building Height:
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Name WJ14 •P�a Name: f- lC►r f_',L!1 i)O I-..) P�
Address:`3C9qt mpany: V�I TH �L j (�,
City:N oY f`M ""//�� State:C Address:3Qq-) G*0- e n
Z I1 /x_iLPz
Zip Code: '3(SO Fax: Al)q City: korc}7�O � Stater
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Phone Nc al . J Q Lto Zip Code: 30071 Fax:
E-Mail: kka 1 '. ) V f JK Phone No 1
Fill in fee simple Title Holder on next a e)if dill re E-Mail
mvn, i 4 ) c
from the Owner listed above) Cam State or County Licens�('G 15 T�
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If value of construction is12500 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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER � _Not Applicable MORTGAG COMPANY: _ Not Applicable
Name:Moil hz'� . v l n Name:
Address:3 C;O Address:
City: ANow er- State: P3F City: State:
Zip: i' q U o a Phone a 1 L�' Lor I(O `d (SDI Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as)ndicated.
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 n r or an attorney before commencing work or recording our Notice of Commencement.
Signature of Ow L ontractor as Agent for Owner Signatu Contractor/License Holder
STATE OF FLORIDA STATE OF INDIANA r
COUNTY OF J6 Y"e fit al COUNTY OF HAMILTON
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization V Physical Pres�oro • a Notarization
thi T ay o 2020 by this 29 day of2020 by
L 161,
Name of person makin tatement. Name of person mJng statemehl.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced o d f ift Produced
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(Signature of Notary b t I i _(Sig ure of Notary Public-State of Indiana )
�1 O ® (Seal) Yvonne M.Senesac
Commission No. a Qf'°
Commission No. 0664315 = •�*�• : Hamilton county,IN
;�•.S t My Commission Ex fires
�OFfl February 19 2023
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE j
RECEIVED
DATE
COMPLETED
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