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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED nn
Date: Permit Number:
Sr.F_'_LCE
Lr V po;
� ° 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: Cie
SS poor K-pl&QA-e '
',PROPOSED IMPROVEMENT LOCAT10"N:
Address: If ODD Ali ll. 4 -C- EL .3 Y9 S7
Property Tax ID#: 7 S1,� ` 70(-OOy7 _ QDO-,7 Lot No.
Site Plan Name: Block No.
Project Name: (o
DETAILED DESCRIPTIQN OF WORK:'
�f _ .. ,gyp � •...y '.
e di ci rf 4 y..-l Allln4 d! a�L SkZAB
New Electrical Meter Second Electrical Meter
Y
CONSTRUCTION INFORMATIONt{
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters 1 Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $IS d�-o 00 Utilities: —Sewer —Septic Building Height:
OlNNER[-ESSEE: =R ; CONTRACTOR:
Name 0 tr Name: Xdoe o4,,
Address: J[ 00 S, ®Cpa, 00'dz !t"C Company:/ 'rl .r7 1,6"-r
City: Tehk_'. &QCk State:F1_ Address: 6S7
Zip Code: -� % Fax: City: State:
Phone No. Zip Code: _?yQS) Fax: 772 .33Y-dL70
E-Mail: Phone No 771- 3.3Y -)-700
Fill in fee simple Title Holder on next page(if different E-Mail- n lon e Il{,.e b ui l6(e.,l S-Ate txf
from the Owner listed above) State or County License (' 6 G 1 Q 7 9V&
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.
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 re ded in the public records of St.
Lucie County and posted on the jobsite before the first inspection u inten obtain financing, consult
with lender or an attorneybefore commencingwork or recordi o r Notice of Co mencement.
Signature of ner/Lessee/Contractor as Agent for Owner Signatur of C tractor/License Holder
STATE OF FLORIDA �� A
I STATE OF FLORIDA
COUNTY OFy I �( f,> COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed'before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this&_day of 2020 by this�day of 2024 by
Name of personirnaking statement. Name of pEgon making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
oduced Produced
(Signature o ?Odt Vb n Florida) (Signature of Nota P4bli4,Stj41�iQrd &.Dianna of Florida
n d. 'V mission GG 098988 �;a rl n �� Knight
Commission Ct! oc �cpues 05121/2021 I Commission No. << '� My commissioNG a1B988
Expires 05/2112021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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