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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED G� �^p��
Date: Permit Number: [?1a 1 - Y^J0D I 1
Building Permit Application
Planning and Development Services
I
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
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PERMIT APPLICATION FOR:
F�tt.,,7[ •-"eta -�.. 'r's3�j� v �_> nW '+�w•'
�PF IPOSE®-1�/��PRO -M NT LOC TI0 1
Y' 3.,.�.c�..i>c;�t.d3.Z`'N $ �v:,�lsr...s�+. .cam.:.. ..- .,.,:Y.gib!; ..taku_� 1_ •,
Address: o-N p Property Tax ID#: S L� ��+ �y Orb.J U�o Z Lot No.
,Site Plan Name: Block No.
Project Name:
rfix, T� E ; GRT INK'�� r :GY�;D1a Y r X
_ .'9 r :.4 nl
r,/F L14
s-z 69-n- J/(-%,
-1-M &Vavc,�,
New Electrical Meter Second Electrical Meter
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: Sq. Ft. of First Floor:
Cost of Construction: $ ( Utilities: —Sewer ,Septic Building Height:
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''.�.,.,�5'4•t�..3`cr��`a��2C-�� m G:°•A°�r'�r``r 'L'l tasy2 +,., 'YZ:�� ''z- w'4�<Ii -E'ir'�i'��'f4 ..`L,J���r.'•4��-�i_-.�.
Name ( �� Name: (_7o .tr o Irr IJ
Address: �&VNv�wc '_ Company: 1, 1^yb Nii O l t3 I Nc
City: L State:�� Address: 17 2 C Ir`
Zip Code: 319om. Fax: City: S State: `t
Phone No. Zip Co e:7 r 117 Fax:
E-Mail: Phone No 772- 3-76 //S L/
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.
$t1PP EM+EN7f L CEO gTULTLI`ELUV N 0_0 (®Y
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: 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 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 OV'JNER:Your failure to Record a Notice of Commencement may result in.paling twice for
improvements to your property. A Notice of Commencement must be recorded Wthe public records of St.
Lucie Coun,ty anti posted on t,}i''e''ff jobsite,before the first inspection.,If ou intend,to obtain financing, consult
with lender organ attorne befdre,tP.Amenc_in work or recordin :'`oui�1'Votj e of Commencement.
Signature ofOwner/Lessee/Contractor'as Agent for Owner Signaturd`o i2O 'ntracto-r iFie se Holder
% 7.
STATE,OF FLORID STATIE OF FLORIDA
COUNTY OF , COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
Physical Pr ence or Online Notarization Physical Presence or Online Notarization
this�day of 202p by —thi s�' day of 202t by
9 /\AC
Name of person making statement. Name of person making statement.
Personally Known OR Produced identification Personally Known OR Produced Identification
Type of Identification Type of Identification
oduced Produced
Si afore of Notary; t+trc tee>5 'tcr" nature:of,Notarytic ,y�
�J I/1ol:r:t,IA INGRA?yt-RAHMING t r;, CO viiYliSS10N'>GG275
Commission No eiy.C'114 �r�#GG275060 Commis ioh�tl r,n,.� c r, �ber20,20ea
E..XF=iE;ES:December 20,2022
Thru Notary Public Un :..J i1;ru Notary Public Underwriters
' denwiters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.