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All APPLICABLE INFO MUST BE COIL'.. __TED FOR APPLICATION TO BE ACCEPTED
Date: 17 1 Permit Number: Aota'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: -
Address: !S-z U Z S 16517
✓ �r P% L C l.
Property Tax ID #: 4=10 � � —��� C� ^000 z Lot No.
Site Plan Name: Block No.
Project Name:
v Csh is Gr ^uz
F,11/1 ill Ci I �Qrt4d
New ElectricaVAeter Second Electrical Meter
COBS R s,TI'@ InI�rR4 a £ATh®I.
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors _ Pond
_ Electric _ Plumbing _ SSpriinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: (5m.00 Sq. Ft. of First Floor:
Cost of Construction: $ fSif�(,�CL__ Utilities: —Sewer —Septic Building Height:
K+." �"�` �^���v .�i.r+=
OWNER%L ,w4 �fffl w
; ril"1C'G. c d � x'l aX. 32:3Sv. 4� . a,' 5 ��'�P.�..c `ka saa�- -seu :u ,v,SS'Y=Fi'r..: ..f'�'S�fiti-.3'=. 1 � r.Y," . fi' .9Y�"'"" ,
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Name cloid,d Name:
Address: (�i�► „kN �c� Company:
City:WIVS?
State: _-- Address:
Zip CFax: City: State:
Phon02 �Zip Code: Fax:
E-Mail: ohs aklw cal i aC_Qc1JI 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.
011
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY:
Not Applica ble
_
Name: or -t -f 5 o of
Name: v '
� e Svv C!
Address: 9 r(sr AvplA
Address• E24
City: ZAA.,6W State
/
City:?-Ppr
State• Z
O CI
Zip: 7-109! Phone
Zip. Phone:
66
FEE SIMPLE TITLE HOLDER: _"flot Applicable
BONDING COMPANY:
of Applicable
Name:
Name:
Address:
---
Address:
City:
City:
Zi / Phone:
p' ..
Zip: /!- Phone:
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OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and mstauation as rnaicdwd-
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 tq Record a Notice of Commencement may result in paying twice for
improvements to your proper yf. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on lb-ejobsite before the first inspection. If you intend to obtain financing, consult
,.,,,rU „r rornrHincr ximir Notice of Commencement.
wtLri ieriuer ur
fm_of-ow�Wer
essee/Con ctor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FL
STATE 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 Presence or Online Notarization
Physical Presence or Online Notarization
thi(sk day of 6J ��_ 2020 by
& . n �/�
this day of 2020 by
94
Name of person making staternento,
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
r duced
Produced
Vigr9ture of Notary Public State of Florida
(Signature of Notary Public- State of Florida )
Commission No. LASHAji", gggM-RAHMING
Commission No. (Seal)
MY COMMISSION # GG 275060
EXPIRES: December 20, 2022
onded Thru Notary Pu
lic Undervirtters
;R R
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Rev. 5/ b/20