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FFAII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: pl Permit Numbe / �� v--u
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Building Permit Applic tion Nov ;;;
Planning and Development Services Permitting ,. ;�p•- rt rr. , r . ,
Building and Code Regulation Division St. LUCie Co
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ;
PERMIT TYPE: rn'o � )a"
Address:
Property Tax ID #: �`i — �O� 0 0 60— O00/0 Lot No.
Site Plan Name: W'� sm Block No.
Project.Name:
Additional work to be performed under this permit— check all that apply:
6echanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ ectric C-15 'lu—mb-ing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: o � Sq. Ft. of First Floor: ��
Cost of Construction: $ z Ira z5 Utilities: —Sewer —Septic Building Height:
Name l_010ASo 5 11L0 1 �4 V111057 Name:
Address:32-00 S ` L4 S� t" b Company: .Z.e
City:- o,+ 'PFeire'o rI lA" State: _ Address: IS
Zip Code: � i 9 &-z Fax: .40 q _ Y321 City: - a'r � joiy State:/":;u
Phone No. `172 (oZ(o - 5-wfb2 Zip Code: 3•i/?£ -2, Fax:
E-Mail: S h �6'e i- I S-10 0 OW161 d ) '(0VV Phone No % �'— � " l `fS%
Fill in fee simple Title Holder on next page ( if different E-Mail •�.� �-�� -�•��- 1ge&Y �%
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 HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:' ' �_
Name:
Address: c7,TQ
Address:
City:.. r�,-� .S� ��� State: _,0eZ
City: State:
Zip:y, 48 Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFF1 VIT: 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 OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
-TO
TWICE FOR IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
E BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
POSTED ON THE JOB SITE IIO
WIITH YOUR LENDER: OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.!'
nat e.o _ or/License Holder
e ne essee/Contract as Agent for Owner
STATE OF FLORI
STATE OF FLORID
COUNTY OF
COUNTY OF `
The f�jg�oing instrument as acknowledged before me
The f¢,o�ng instrumgn was acknowledged efore me
iiL/
thisis day of �% , 202Q by
this a:C�1 day of , 20�by
Name of person makingJ tement.
Name of person rhakM sta a ent.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identif tion
Produced r Q U`4C f
Type of Iden U. ication
Produced 1/�( n/,��(V �—
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/
(Signature of No -
(Signature of to Public- State of F rida )
o P?;vr'usve's AUDREY B. HIJMPHREY
Commission No. MYcoMMIgs�`I�GG300817
q. P�
Commission N = °`` ''8��: AUDREYB.HUP�e1��Y
EXPIRES: March 6, 2023
;*= MISSION # GG 300817
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.E o"'�°c' ded Thru Notary Public Underv+riters23
�;94G� �: EXPIRES: March 20
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erwriters
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