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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Date: j % �
Permit Number:
Planning and Development Services Building Permit Application
Building and Code Regulation Division
2300Virginia Avenue, Fort Pierce FL3498Z Commercial----- Residential V
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: 1 pn (2_ T tP L
PROPOSED IMPROVEMENT LOCATION:
Address:_
Property Tax ID #:
Site Plan Name:
Project Name:
Lot No. at�a_
Block No. `J
DETAILED DESCRIPTION OF WORK:
e-in rry 4no
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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 _ hoof
Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ `T a Utilities: — Sewer — Septic Building Height:
i
Mri�
[CONT�RACTOR-
[Na�NeC
tr C� u
�' State: L- Address:
'Zip Code:a H �J Fax: City: �h Fax:
State:
Phone No. o� Zip Code:
FL
E-Mail: Phone No ✓ `i-7 0, 45 3
YeARQu—
Fill in fee simple Title Holder on next page (if different E-Mail SSl I'Yt
from the Owner listed above) State or County License +
If value of construction R 5500 or more, a RECORDED Native of Commencement is required.
If value of HAVC Is $7,S00 or more, a RECORDED Notice of Commencement is required.
SUPPLEiV IwNTi4 `CONSTRUIPMON LIEN LAW
i?ESIGNERfENrrrur�n. - - -
Name: -_... Not Applicable
Address:
City:
Zip: � Phone State:_
FEE SIMPLE TITLE HOLDER:
Name: � Not Applicable
Address:
City:
Zip: ---� Phone:
OWNER/ CONTRACTOR pp
I certify that na work or inst iAFFIDIIFT: Application is here,,
Fr'uK I.WATIM =7.7
MORTGAGE CQNiPANY
Name- Not Applicable
Address:
City:
Zip: Phone: State:
BONDING COMPANY:
Name: ---Not Applicable
Address:
city.
Zip: Phone:
a latron has cornrnenced prior to the issuance of a permit.permit
St. Lucie Counttyy p rmit to do the work and installation as indicated.
which is in conf maev es an representation that is granting a e
ill
structure. Please consulty applicable Home Owners A perm rules,
authorize the permit holder to build the subject structure
With your Home Owners Association and review your deed for any restrictions which may apply.
ssoion ion rules bylaws or an covenants that may restrict or prohibit such
Inconsideration of the granting of this requested Permit, I do hereby agree that f will, in a[(res
in accordance with the approved plans, the Florida Building Codes and 5t. Luge County Amendments,
The following buildingpeas. perform the work
accassa permit appli�tions are exempt ants.
rY structures, swimming p from undergoing a full concurrency review: room additions,
WARNING To g Pools, fences, wa!(s, s(gns, screen rooms and ac'cur
O OWNER: Y faii€zr2 to Record a Ns�tice of Comm cess'�' uses to another non-residential use
Improvement to ya
LLICie Cniiniq�
signature
STATE OF
COUNTY(
°PeftY• A Ncstice of Carrlmencemen�mu�nt e,ar
n the jobsite before the first ins❑arrr.,,,7,��._..
Agent
0
S n to ( r a rmed) and subscribed before me of
resence orr„�` Online Notarization
thisaY of
Zi)zt by
- -er Y a
Name of person making statement.
Personally Known _ OR Produced Identification
TYPe of Identification]�
(signature of v °^ • t Vwa v
Not Publ(e-State of Flo
Commission No. 4yr�
:REVIEWS FRONT
COUNTER Rm e'tm- !ISOM
Signature
STATE
3VIng tautce for
the public records of St.
obtain financing, consult
Sworn to V.ia
irmedj and subscribed before me of
desence or Online Notarization
th s o�
Za2Q by
Name of Person making statement.
Personally Known `OR Produced Ide t! ca
Type of Identification tian
Produced
{ ign ure Nota
;ommission No. Ke Pu' Of Rxida
e
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VEGETATION I SEA T613; E� MANGROVE REVIEW REVIEW
REVIEW