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All APPLICABLE INFO MUST.BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: Permit Number:
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: "
_ PROPOSED.IMPROVEMENT LOCATION:
Address: J0751 5 OCca� i_\• PW
Property Tax ID#: LI511 311 001.5 -Oa 0 -L( Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
R c FOL wire s 4o 'I 5-Po,w r
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
X Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 150 Utilities: _Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name AINO'E' ?cop 1V Name: _30�1v\ CAzd gcYO
Address: 1'6% r Company:
City: W,I r"i,40e\ State: DE Address: 21 2(a Sw AZudC AVC_
Zip Code: !qf)Q Fax: City: 1911, '57. luc<<. State: r-L
Phone No. Zip Code: 34 9 S 3 Fax:
E-Mail: Phone No ?77.- 52 S! -Z 129
Fill in fee simple Title Holder on next page(if different E-Mail vow-E1ccl'i C MOW{,Cap n
from the Owner listed above) State or County License 311K�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of.HAVC is$7,560 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:
City: State: City: State:
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 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 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 attorne ..before commencing work or recording our Notice of Commencement.
All—
Signature Owner/Le ee/Contractor as Agent for Owner Signaturetof Contrac r/License Holder
STATE OF FLO I?A / STATE OF FL DAf
COUNTY OF_ • (�uC r COUNTY OF �• (emu t r
SXv9m to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Pbsical Presence or Online Notarization P sical Presence or Online Notarization
this 1 day of_ I'f 5 �0 by this IEL day of J-r 260 by
I Z_JAC-co, '���n vl „a� Na e-
K r
Name of person making statement. Name of perso m king statement.
Personally Known OR Produced Identification _ Personally Known OR Produced Identification
Type of Identification Type of Identifi at'
Produced —C._ Produced
(Signs a of Notary Pu Q aorida),Joseph Gomez (Sign a of Notary Pu lic-StaX�`, �rida) Joseph Gomez
Go mission#GG161404 /� 0@@� mission#GG16140
Commission No. lT G I -�` = �s;November 16,202 Commission No. : :*`( �
9• ;�; S5, xpir s:November 16,.20 1
JF_ bQ Bonded thru Aaron Notary, �9 iiF Bonded thru Aar
on Nota
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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