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All APPLICAB IN MUST BE COMPUTED FOR APPLICATION TO BE ACCEPTED
Date: 9
Permit Number:
c L L_LLL
CS.,� F>
LY ��
Planning and DeveloPmentServices Building Permit Ap cation
Building and Code Regulation Division
2300Virginia Avenue, FortPierce FL34982 Commercial Residential
Phone: (772) 462-15S3 Fax: (772) 462-1.578
PERMIT APPLICATION 1=4R:� n ! �C
OPOSED IM
PRPROVEMENT LOCATION:
Address:
Property Tax ID #: �-
Site Plan Name:
Project Name:
FDETAiLED DESCRIPTION OF WORK:
� S
New Electrical Meter Second Electrical Meter
CQNSTRI.ICTIQN i NEORMATION: � �� � � -r
Lot N o,�
Block No.
lR
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 R IF
Total Sq. Ft of Construction:
Cost of Construction: $ 151� -
OWNER/LESSEE:
00_ Pitch
Sq. Ft. of First Floor:
Utilities: _, Sewer `Septic Building Height:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
Company: but -
city: stare:FL
Zip Code: Fax:
Phone No77�2 ` 145 3 ` -`
E-Ma i I S4ErkCVA I1r14 mS Gi l
State or County License Ab,K( nt
If value of construction is 250o 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.
SU PL/I �Tol LDN5TRUCTl0N-L[E1 IAUV fNFORIi I`ICiN:
—ES-1GNEFV/ENGtl_�ra
Name: Not Applicable
Address:
City:
Zip: --�-�_ Phone State;
FEE SIMPLE TITLE HOLDER:
Name: Not Applicable
s:
Addres
City:
Zip:----�� Phone;
MORTGAGE COMPANY:
Name: Not Applicable
Address:
City,
dip:r Phone: State:
BONDING COMPANY:
Name. —Not Applicable
Address:
City:
otniNER/ CONTRACI'i7it fp' �---- Phone:
i cent �4FFIDVITr Application is hereby made to obtain a e
certify that no work or installation has commenced prior to the issuance of a permit.
St' Lucie Count� makes no representation that is granting dPria permit to do the work and installation as indicated.
which is in conflict with an a permit will authorize the permit holder to build the subject structure
structure. Tease consult with your Home Owners Association and review your deed for any restrictions winch m _
Y Pp icable Home Owners Association rules bylaws or and covenants that may restrict or prohibit such
inconsideration of the grantingof
in accordance with the a e this requested Permit, i do hereby agree that I will, in all respects, perform the work
ly.
emit applications
Plans, the Florida Building Codes and St, Lucie County Amendments. respects,
The following building permit applications are exempt from undergoing a full concurrency review; room additions,
accessary structures, swimming peals, fences, walls, signs, screen rooms and accessory uses to another non-residential WARNING'TO OWNER: Y id
improvement to yo r p p ilert tO Record a Notice of Commencement relay Ares use
f,ucie Coup a p Y A Notice of Commencement mu a ratheg b f�ecords cif St.with lender or a p led n thejobsite before the first inspectia . If ou obtain financing, s of Slt
tome before commencin work or recordin vof rN_ -� —
Signature
Agent for Owner
NTY
STATE Of! L �RIDLA
5Tn to (cir a frmed) and subscribed before me of
re a Online N tarization
this -day of `
202 by
)r c '_
Name of person making statement.
Personally Known __._ OR produced Identification
Type of Identification -_-
,-.U, • .w. V ❑r fvotaFY public -State 4f
Commission No.
REVIEWS FRONT J'�
COUNTER R�
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41(� r•rr r.w '7
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rev
y` MafarySe,�
Signature
STATE C
Sworn to r a � irmed) and subscribed before me of
a! re r Online No arization
th s d of �`
20by
Name o�PerMSGn �Maklnggtatement.
Personally Known OR produced Ide tl catlan
Type of Identification --��
Produced
( ign ure Nota
:ommiss(on No, N YPUNCS *
e Kan 141��
ov less � W2024 �7938
VEGETATION SEA TURTLE
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