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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4 as Permit Number: a,a
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
RKEIV '
Building Permit Applic icie County, Permitting
Commercial Residential L_—
PROPQSED IIVf'PROVE,MENI LOCATION w+�
Address:
Property Tax ID #: Sb Ol— p 11z1::S< Lot No.
Site Plan Name: \V e. l.E..9 M1:P%\%fiN Block No.
Project Name:
CONSTRUCTION INFORMATION;
U
T
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric — Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ LA d4a . dd
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE
;;.CONTRACTOR
.. Y.
t, t
Name
Name: �.
Companyl Sc�:�lnon.e:S
Address:
Address: 8R0_!S
City: SCAN%ft—s State` L-
Zip Code:34A_=� Fax:
City C� .���c C�
State:��
Phone No.
Zip Code:3yOyb Fax:
E-Mail:
Phone No
E-Mail
Fill in fee simple Title Holder on next page (if different
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.
SUPPLEMENTAL CONSTRUCTION LIE N LAW -"INFORMATION
DESIGNER/ENGINEER:. _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name: 1:evok oLe-W.A.Name:
Addres O • FIB im
Address:
City: d& eA A%ft VkIE
State: V-_
City:
State:
Zip: -s1Lk "�a 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 OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owne / Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLOR A
STATE OF FLOgIDA1 _
�
COUNTY OF�� `,t�c_�
COUNTY OF
The forgoing instrument was acknowledge before me
`
The or oing instrument was acknowledRe�before me
"�'C�r
inn . 0 by
this✓ A� day of
this day of , 2d_Jby
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known FOR Produced Identification
Type of identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Pub'
Commission No. 1o�Y °�e� •.: (Se�ITjELLA M HUNTER
Notary Public State of Florida
:: �iaY Pu' •.. STELLA M HUNTER
Commission No. a°:.,�'��; Notary ��r)State of Florida
Com usion s GG 281062
:r
Commission # GG 281062oar�°
_ 9 c`€
My Comm. Expires Jar. 23. 2023
Bonded throug
i National Notary Ass .
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DATE
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DATE
COMPLETED
Rev. Z/7/19