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All APPLICABLE INFO MUST_ BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c� OJ Permit Number:, \0--�,"(5()1
S`rc LLLL-L T RECEIVED
EaCIwr, l FEB - 3 2021
L L• o' C� U L t� --
Building Permit Application
Planning and Development Services , PerSt, Department
SC. L le County
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: C!e.� f0 . WUZ,
Property Tax ID#: ,3 k o (a 0 l)0-� 6066 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
OP
i et/ v
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 _Roof Pitch
Total Sq.Ft of Construction: � �� Sq.Ft:of First Floor:
Cost of Construction:$ / _o 0 Utilities: —Sewer'
—Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: e' . .r ",J� C, C,
Address: %D3 . 1(6 0 c �17 Company:
City: Fe,fl i iPP Fn GE State: y'G Address: r
Zip Code: 3�'/��,� Fax: City: +✓u State:4/__�_L
Phone No__q/-79)��A)/ 5- Zip Code: Fax:
E-Mail:..t uye Gyyv►g 1-.Ca/.w+ Phone No ,
Fill in fee simple Title Holder on next-page(if different E-Mail JQ /1 ,(dA4
from the Owner listed above) State or cou y License C6,6 f ��� f'3?
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.
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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,1 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 post d on the jobsite before the first inspection..lf you intend to obtain financing, consult
with lender or an atWney beforegommencingwork or recording. our Notice'of Commencement.
Z
i ature of Owner Lessee/Contractor as Agent for Owner Signature of,Contractor/License Holder
STATE OF FLORIDA STATE OF FLOJYDA
COUNT Y OF k. L 3 C r COUNTY OF c\,�
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed.before me of
Physical Presence or Online Notarization _Physical Presenc or Online Notarization
this%_day of 2026 by this -'J day of 2021D by
�6e ti N���5 . ��i3s- N",
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 L Produced 1- '
ll
(Signature of Notar, ublic-State o Florida j (Signature of Notary blic-State of Florida)
—AUDREY109)APHREY Commission No. n:r, AUDREYg9EYJgPHRCY
Commission No v P;. �''"� s
r ° MY COMMISSION#GG 300817
MY COMMISSION#GG 360817
n n FFc Cen edTllruNe9 Pi!'licUnd4ti+.tee.:
tam l Pubis
REVIEWS - � r a" R PLANS VEG 1(N�z: F ft i i i. RfJ.
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW,
DATE
RECEIVED
DATE
COMPLETED
lev.5/6/20