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All APPLICABLE INFO MUST BE COMPLE ED FOR APPLICATION TO BE ACCEPTED
Date : \ � .� 1 oLc)v�- � Permit Number :
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Buil ding Permit APPI ication
Planning and Development Services
Building and Code Regulation Divi si on Commercial Residential
2300 Virginia Avenue,, Fort Pierce FL 34982
Phone ,: ( 772 ) 462 - 1553 Fax : ( 772 ) 462 - 1578
PERMIT APPLICATION FO R :
PROPOSED -. IMPROVEMq J
ENT LOCATION :
Address -P �f - �"1 Y 1G 1 C�. ' W
Property Tax ID # .0 — Lot- No .
Site Plan Name : �� ► � ��dt
Block No ,.
Project Name :
OWN"
JV4 ..M
DETAILED DESCRIPTION OF WORK :. ..........
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m.
mop
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New Electrical Meter Second Electrical Meter
-- ------ ------ -
CONSTRUCTION INFORMA TIO N : = � 4
.... . ........
Additional work to be performed under this permit — check all that apply :
_ Mechanical _ Gas Tank _ Gas Pi ping _ S h u tte rs Wi n d ows/ Doo rs _ Pond
_ E l e ct r i c _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq . Ft of Construction : Sq . Ft . of First Floor :
Cost of Construction ,,: $ ��>-1 . dc Utilities : _ Sewer _ Septic Building Height :
OWNER / LESSEE : CONTRACTOR � �' ;� , r4 , _ � �
......
- ----- -- ----
Name 11 �(� 0.� Name :
Address : - � 1 - � Company :
Ci ty : State : � Address .. ICE10
Zip Code ,., ? FaXW c i ty : VA _ �l �CSL State :
Phone No . � 0�5 Zip Code *, l Fax :
E - Mail : Phone No
Fill in fee S 'lmple Title Hold r on nex age ( if different I E - Ma *11 Cam' • C.� � � '�
from the Owner listed above ) State or County License � � y
If value of construction is 2SOO or more, a RECORDED Notice of Commencement is required .
If value of HAVC 'ls $7, 500 or more, a RECORDED Notice of Commencement is required .
0.
N STRUCTION LIE L I ORM T
DESIGNER/ ENGINEER : _ Not Applicable MORTGAGE COMPANY : _ Not Applicable
Name : N ame :
Address : Address :
City : State City : States.
Zip : Phone Zip : Phone :
FEE SIMPLE TITLE HOLDER : _ Not Applicable BONDING COMPANY : _ Not Applicable
Name : Name :
Address : Address :
C91ty : City :
Zip : Phone : Zi p : Phone ,.•
OWNER/ CONTRACTOR AFFIDVIT@. Application is hereby made to obtain a permit to do the work and installation as indicated .
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. mail restrict or prohibit such
structure . Please consult with your Home Owners Association and rev iew 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 reviews. room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non - residential use
WARNING TO OWNER : failure to Record a Notice of Commencement may result in paying twice forYour
improvements to your property . A Notice of Commencement must be recorded in the public records of St .
Lucie County and posted on the obs ' te before the first inspection . If you intend to obtain financing , consult
w ith lender or an attorneybefore co encoin work or record *in our Notice of Commencement .
Signature caner/ Lessee/Contractor as Agent for Owner Sig a re of Contractor/ License Holder
STATE
COUNTY OF � � � COUNSTATETY OF
Swor to or affirmed ) and subscribed before me of Sworn or affirmed ) and subscribed before me of
� Physical Presence or Online Notarization hysical Presence or Online Notarization I
this It) day of 2024 by t hi s 15 d a y o f , 202� b y
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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
Produced Produced
7.
( Signature of Notary Public- Stat o I ( Signature %f Notary Pu c- e o i a
Jy,� ��� w-rtary public State of Florida � Notary Pu he State of Florida
Commission N � `� r�^ar( q � Montepare ��y � Mar ar t E ontepare
My Cornmission GG z � as9a Commission Na Mr My Con��@sl� GG 214990
()6/0512022
� Expires G6/05/2022
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVI EW REVI EW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. b/ b/ ZU