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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ((��
Date: Permit Number: l I QL_On
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Building 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:
PROPOSED IMPROVEMENT LOCATION:
Address: J r C _6 3 d I PA-/e kS 60L,� fog :e)eC e
Property Tax ID#: 3�f o S o 3 6 0 g 9 0 6 o -7 Lot No.
Site Plan Name: AZi2 Block No.
Project Name: 'l-`A
DETAILED DESCRIPTION OF WORK:::
New Electrical Meter Second Electrical Meter
CONSTRUCTI'ON`,I N FOR MATION
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: 1?3 A Sq. Ft. of First Floor:
Cost of Construction:$ gs.`I b 0, Utilities: —Sewer _Septic Building Height: (5�
OVUN ER/LESSEE. CONTRACTOR:
Name -r J A-16 E6 IZ Name: FX A M P 'J
Address: Sb TRioWe-1,ejLS Company: k c"-�
y: State: �
City: — t—�� =-e+C�-2 1 Address: `fb�q S'w• YI'1Gis� •'e � V1.
Zip Code: Q�a' Fax: �' City: 1"ok2 S Lwt.;, State:
Phone No. 95 Y L7 ! - /Q 7 Zip Code: 3 q 9 r3 Fax:
E-Mail: a P-i IveX aO p u_V-vo Cam-, Phone No L-7a) 6?1 —S 18y
Fill in fee simple Title Holder on next page(if different E-Mail R b y 4 f'& I ' t9� a: . Grim
from the Owner listed above) State or County Liceiqe C C C 1 3 ?j 1 3 a (o
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.
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SUPPLEMENTAL CONSTR CT19N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _ of 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
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
I
is to your prop rty. A Notice of Commencement must be recorded in the public records of St.
Luci nt and poste o the jobsite before the first inspecti . I you intend to btain financing, consult
wi I der or an att n before commencingwork or rec r In our Notic fCommencement.
Signature of O ner/Lessee/Contractor as Agent for Owner Signature of ntra or Lice se Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF `,�,�� Q,_ COUNTY OF o
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pr es , e or Online Notarization Physical Prese ce or Online Notarization
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this day of 2020 by this (,,4—day of o o 2020 by
Name of per n making statement. Name o p on making st tement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Propced Pr uced
M �6
(Si atdr6bf Notary Public- ate of Florida) gna u e oNo _Publi ate_o to ida
.. .. orfl P of LA SHAFINAINGRAM-RAFI[Of G .
Commission No. %�--,-.,. Commis I > '
�9�--tASHAHNA ir#GG
HMING a 9 GG 275 i
F,I ,to• ,.
My COMMISS275060 =9.�..•..oQa EXPIRES:December 20,2022
9'FOF F°c otary P lic Undervrriters
REVIEWS F R PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.