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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: D + Permit Number06) % V 37Y
91To LUCDL
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ty ° 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: i
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PRO_DMNT.O�CATI, N g
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Address: �� �r e (' 1/
I �O - (2 bol !�' b b0 i Lot No
Property Tax ID #:
Site Plan Name: Block No:
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Project Name: 5 i 'C U� Iw>
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DE- �LED�D,E�CRI`PTION Q NORKt t NW
_ is# �. .3n�2 7°`�ii<i`G E
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New Electrical Meter Secong Electrical Meter 3 / C
r�NFO�MTN L„��a.�wr
;fuERUC n °.112x
Additional work to be performed under this permit -check all that apply:
Shutters Windows/Doors Pond"„
Mechanical Tank —Gas Piping _ _,
_Gas
i/ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch..'
Total Sq. Ft of Construction: l Z� Sq. Ft. of First Floor:
Cost of Construction: $ ,poo Utilities: _ Sewer _ Septic Building Height"',_
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Name
Name:
Address: -0 C�
Company:
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City: 1�'�I'�lt'CQ State: YL
Address: "
Zip Code: Y I Fax:
City: ` State:
Phone No. 2. %� Z 2 U1ui
Zip Code: Fax:
II
E-Mail: / r� yt(�� ,dal CIO/ Vi
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 $7,500 or more, a RECORDED Notice of Commencement is required.
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prE`SiGNIY NEER:
Not Applicable
MORTGAGE COMPAN
_ Not Applicable
_
C arn�t; K :' (i rl
L_LC,
Name: (.fLDS
Address: 7
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`Address tY., ( 0 iA
City: ��k(lt
State: L
lit
state: L/
Ip' Phone 1 2
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Zip: �'TO Phone:
SIB ", A (1E HOLDER: _
Not Applicable
BONDING COMPANY:
_Not Applicable
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Name:
1',
/$ddre5s"'�
Address:
.dip , � x� Phone:
Zip: Phone:
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C 1fll i f j G(iNTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to ao the worK ana instauauon a� 111U1LdLCU.
I'ctt�fy #r$(b` Vilork or installation has commenced prior to the issuance of a permit.
�,St udid bUr{�..1,. akes no representation that is granting a permit will authorize the permit holder to build the subject structure
Which is its crsrjltct with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
stiitUtewPla5e consult with your Home Owners Association and review your deed for any restrictions which may apply.
It '6.6midet`atipffof the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
ri;acc01th the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The fbllowing Eidilding permit applications are exempt from undergoing a full concurrency review: room additions,
a�c�s�oryrSf�uC��res, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WANIItifG T1d OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
�r rtA+ Ments to your property. A Notice of Commencement must be recorded in the public records of St.
Lu�)�o.' hty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
i_ __ __ �, .�� ., L—IF 1- rr rv.monrino %AmrL, nr rArnrrlina vni,r Notice of Commencement.
,:'•W9G1-1'1'LG1; CI VI
all llVlllc
o O.Wner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
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ORIDA
STATE OF FLORIDA
'd6UNty,-�f,K, L.•Sc.^t
COUNTY OF
wi5ri to (61#irmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Notarization
f'li'iG(resence or Online Notarization
Physical Presence or Online
thisijy of , 2020 by
this day of 2020 by
`N-6ff .# 6f ( Tia; making statement.
Name of person making statement.
PerSt3rfa)Ij� i�rlD�tln OR Produced Identification ��
Personally Known OR Produced Identification
Ty�sis b`ideri( cation
Type of Identification
Produce ,V
Produced +,
l 4
`.
nature p, N&ary Public- S to of Florida) �,vllu/,,
nature of Notary Public- State of Florida) ti
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mission No. (Seal)
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