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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a I Permit:Number: 2AC)
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Building Permit Application
Planning and Development Services
Building and Code Regulation Vvision Commercial Residential
2300 Virginia Avenue,Fort Pierce Ft 34482
Phone:(772)462-1553 Fax:(772)462-IS78
PERMIT APPLICATION FOR:
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Address: tiggA i trL4ner Cx-mg Ou;+TtiPxP¢GJ 4,qQEt
Property Tax ID#: I?b n-ly 2.-Poi?i-Ono-1 Lot No,-..
Site Plan Name: 5� .luci-P Co LallthtS Block No.
Project.Name: 1 ACAP- Co Ubli0t5 LIIJ Cr!:ff�'k'- 'y, p fa h'
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New Electrical Meter . Second Electrical Meter
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 Rtto��of Pitch
Total Sq.Ft of Construction; Sq.Ft,of First Floor: ,"7
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Cost of Construction:$ Utilities, Septic Building Height:,
Name 5k Lk cle .Co yir.\D ES - Name: 5 me.S A4aNP.r
Address:L W(Rt C<aA.t r C,ee,eg DQ Company:MC ct a(A1her4.
City:4 Qiere2. State:,, Address:���' S£ Cl. 2`Z\
Zip Coder?,ug51 Fax: City: S)nni:o Stater
Phone No.Sot-5S'3-43 Ci . zip.Code: 17,7 nG 1 Fax:,15 .Ad 9'•Il)3
E-Mail.Sky_6 61C@64.1He i2CV,OcQi Phone No QS -i l-li? �z 23 21
Fill in fee simple Title Holder on next page(if different E-Mai1,� CM1t�S�1 r yjrai 1, C1M
from the owner listed above) State or County License C?cas 1oict 5
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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DESIGNS ENGINEER: _Not Applica a 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 A livable
Name: Name-
Add
ress
City; air
Zip: Phone- Zip: Phone:
OWNER/CONTRACTOR AFFIDVfi: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 permIL
St � je Cou m no repressr�tation that is granting a It Ai authorize thhee unit hoXMIgin to build the �jed
s cture�Pl� consult t�rpyo Home Owners Associationand ni mew youur�ead for airy restrtcttoru�whtcti oaf t such
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 plats,the Florida Building Codes and St.Lude County Amendments..
The following building permit applications are exempt from undergoing a full c ancurrency review:room additions,
accessory structure.%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 record
Lucie County and posted on the JobsRe before the first Inspection.If you intend to obtain financing,
with lender or an attorney before cotthmendn work or records our Notice of Comment.
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Signature of Owner/Lessee/Contractor es Agent far Owner Slgnatu W ContractarNcense Holder m-2•
STATE OF FLOR119A STATE OF FLORIDA 2='
COUNTYOF _sTe tn* km c 60r1 COUNTYOF QRkORDRb Y y
F. T N
Swgm to(ai afftnned)and subscribed before me of S
WDm to(or affirmed)and subscribed before me of 5 o
Phgstcal Presence or Online Notarbation _Physical Presence or Online Notarization a w
this day of l�eb. .2G2¢by this_day of FMBV 2020 by a
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Name of person making statement. Name of person
;���P •. MARIAR.BURGIN = -
Personally Known y J OR Produced Identification Personally Known
Type of Identification Type of identification Expires August-15,2023 =
Produce Produced Bondod Thru Troy fain Insurance BOo- 7
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( afore of Nota Pub4 �� FlocIAMANE WARD (Signature of Notary lo-State of Flo a)
Commission No I iurouA2azort
* # CommiNlontl11%2 7118 Commission No. (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
i
DATE
COMPLETED
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