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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED •�
Date: �I �2v2/ Permit Number:^� ]� 7
•
�1 RECEIVED
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-- - Building Permit ApplicationmAR 01 2021
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie
2300 Virginia Avenue,Fort Pierce FL 34982 Countyv
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: J)x)#ve w
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FU{ EY.�LLIy4la 'E-->. <.?< .rR_ ter. -.....;:{ .£<--=.. _ "'-'.-w �'�:,,
Address: 36� A!7�IO��� S� r �f . �j Q rC� FL
Property Tax ID#: —g (2, " lava.) Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: /'3�� Sq. Ft. of First Floor:
Cost of Construction: $ ����� Utilities: —Sewer _Septic Building Height:
£ 17'N€fLFf=E a 4 z s s CQf�ITf ► Tt?Rr � � s T x
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Name dt*wo Z ( ioa Am('C7 45 (Name:
Address: 36� ber(LOL v 5/1 Company:
City: q;r. elf rce State: �711r Address:
Zip Code: 3 l Z. Fax: City: State:
Phone No. T- L 1(-571 Zip Code: Fax:
E-Mail: SUY beak Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
n Qe Aje f
jee CIFSignature of Owner/Lessontractor as Agent for O r Signature of Contractor/License Holder
STATE OF FLORIDAA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I day or?7 0 20� Jlby this day of 20_ by
Name of person making statement. Name of person making statement.
Personally KQown OR Produced Identification ✓� Personally Known OR Produced Identification
Type of Ideln-tif'ition Type of Identification
Produced ... Produced
(Signature of Notary Publi - t_ate f FL +ri -
�( �U p (Signature of Notary Public-State of Florida )
Y! t'flYP a AUDR[Y B.NUPv1PHREY
Commission No. 2iI °4 ,''`s=
, _ MYCC(§APJ�I0N1,1GG380817 � Commission No. (Seal)
r ` ' EXPIRES:march 6,2023 E
aanvrif rs REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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