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All APPLICABLE INFO MUST BE CON•'rED FOR APPLICATION TO BE ACCEPTED < i
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Date: A'`Z� �� Z n'Zd
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Building Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34952
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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Address:��
PropertyTax ID #: �3 4X>`3 Ca 1G � / Lot No.
Site Plan Name: �J `� d �—r4 SS P 4 �% �-' Block No.
Project Name:OE
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New Electrical Meter, Second Electrical Meter
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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
_ _
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Total Sq. Ft of Construction: `� `J Sq. Ft. of First Floor:
Cost of Construction: $ % -3b%Mc2 ,p Utilities: _ Sewer _ Septic Building Height:
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Name FR41 sto., I �c'ZS®�1�
Name:
Address: sL ooCSJ I �i ��-
Company:
City: PT i State: FL-
Address:
Zip Code: '7— Fax:
City: State:
Phone NoS (o k - r> -
Zip Code: Fax:
E-Mail: -F C L_tg�� to QC�S�ric�1 L
Phone No
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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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: ,-Not Applicable
Name:
Address:
City:
Zip: Phone
MORTGAGE COMPANY: .Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Adams:
cite
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the worK and instauauon as I nalr dLUU.
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 forany 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 paying twice for
improvements to your property: A Notice of Commencement must be recorded in the public records of St.
Lucie gounphand posted on the jobsitp before the first inspection. If you intend to obtain financing, consult
�_ .. �� ., ,., f,, , ., ,.,.o.,��.,Q wi-arle nr rprnrriing your Notice of Commencement.
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Si ureof 0wne essee/Contractor a Agent for Owner
tractor/License Holder
S TE OF FLORID
STATE OF FLORIDA
C UNTY 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 Notarizatio
Physical Presence or Online Notarization
thi A day of Q4 20
this day of 2020 by
CZ IL
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
Pro ced
Produced
(' to of Notary Public- S to of Florida)
(Signature of Notary Public- State of Florida )
__ - --_ NGRpi�q
M.gARMING
Commission No. ; YPe' LLAST SION#GG275060
Commission No. (Seal)
MY cOMM1 2022
December 20' •ters
:a• EXPIRES:
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aF
FRON
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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DATE
RECEIVED
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Rev. 5/ b/W