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Rttllding Permit Application
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RERM1T APPLICATION FOR: � � l;: �; tr rc: Al �' r .Y• �� r:-
IPROPOSED tMPROVEMENT LOCATION, � _._._ -� _. . _....-___�_ ___.._ _._.____ _._ _ .__ ___ __ ✓�
r Or.%er-tv Tax IV. N �„ �.�1.t�3' �,,, r -7— ( lot NO.
S tr Pt an Name, Block No.
t'rL:>n't N, rnr,
DETAILED DESCRIPTION OF WORK:
?;e v% E eatnca' Meter Second Electrical Meter
" Co%IS ; RUCTION INFORMATION:
Additional wort, to be performed under this permit —check all that apply:
Mechanical
Clemic
Gas Tank
_ Plumbing
7— t 1 S;;- F: of Construction:
Cost of Corstru:tion: $,`rr•
OWNERAESSEE:
_ Gas Piping , Shutters _ Windows/Doors _ Pond
_ Sprinklers _ Generator ^ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer — Septic Building Height:
NaMe
Address: Or7 -{--
city: �- T�1Q ! L {, State:
Lk -
zip Code: 7 14 Cl 0l Fax:
Phone Na.
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
CONTRACTOR T
NarTle:� & /fe_ SN`t7tL
Company: C C n. , i tl- "L SO.01, i:c_( 11E_.
Andress: . o 2
City: � ,,. ,� � 1%y state:
Zip Cade 114(-I - Far:
Phone No �,•', , C', i 1
[-Mail K,•, , r-t'
State or County license
t
if value of conlructbn is ZSW or more, a RECORDED Notice of Commencement Is required.
If value of HAVC Is S7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
^ Not Applicable MORTGAGE COMPANY: — Not Applicable
Name:
Name:
Address:
Address:
State:
City:
State: City:
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 noyrepresentation that is granting a permit will authorize the permit holder to build the subject structure
structure. conflict with
with your Hlome Owners Association iandrreview your de d far any r strict ons at wh ch may ct apply obit such
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 paying twice for
improvements to your property: A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement. i
Signature of Owner/ Lessel/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF .ST- i;Q c-� e-
Sw rn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 10 day of 00 e_P wi3er" , 2020 by
Name of person making statement_
Personally Known OR Produced Identification k-
Type of Identification
Produced of, Li C
Notary PUD6c State of Florida
t �1/1G1 P /il/1 �JJ: Mona Leon nn 230893
Signature Contractor/License Holder
STATE OF FLORIDA
COUNTY OF S,T" I_ Q t--t r
Sworn to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
this _(,Q_ daylof ae-G--&%p ,- , 2020 by
G�e.larJ S*-%L-r-tit-
Name of person making statement.
Personally Known OR Produced Identification,
Type of Identification
roduced D.(. L,V
�Notary Public Sala of Fldtoa
(Sig azure o otary Public-tn�orIDlprj s 06n=022 Signature of Notary PublicMV
i�i ro ,,,w GG 230893
■gref o6rM2022
Commission No. ZS6 (Seal) Commission No. Z30
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER I REVIEW I REVIEW REVIEW I REVIEW I REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
MW". AM