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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � C Permit Number:
������Jo\�Jr]u�(�b���� - RECEWED
MAR 01 2021
Building Permit Application
Permitting Planning and Development Services St. Department Lu ' unty
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 IMPROVEtMENT LOCATION:
Address: \ A e�?��C'�1
Property Tax ID#. V54 "Goo`'yC.;>tq —cjC;'CD Lot No.
Site Plan Name: 11W1 LO 44- V� Block No.
Project Name: t, LA-> .11 XZi— z;>n ®C>NF-
DETAILED DESCRIPTION. OF WORK:
New Electrical Meter Second Electrical Meter
FCONSTROC'TIO"N .INFOR'M'A"TIQ';N"' ,
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Win /Doors _Pond
_Electric _Plumbing —Sprinklers _Generat , _Roof ` `ZPitch
Total Sq. Ft of Construction: �� Sq. Ft. of First Floor:
Cost of Construction: $ �LIZ>t> Utilities: —Sewer _Septic Building Height:=l-�
OWNER/LESSEE: CONTRACTOR:
Name ti Name:
Address: e4�5 Company:
City: ��t>5=�� ��� 1 Stater Address:
Zip Codad�� Fax: City: yA���C�G State^
Phone No. Zip COVA�'5b' [� Fax: i
E-Mail: Phone No ' 7�72- —
Fill in fee simple Title Holder on next page(if different E-Mail �✓' t]`D/�4cC�i�� �1�
from the Owner listed above) State or Coun ; Licensees-C V-3;2-tQ'\190�
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,LIEWLAW INFORMATION;..
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
1
Name: Name: I
Address: Address:
City: S' lte: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: j
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
9
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 e), mpt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences, Ils,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 posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
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Signature of wner/Lessee/Contr for as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 6� - I_ i urn COUNTY OF �� • Lye'I ,
Sw-o�n to(or affirmed)and subscribed before me of Swor to(or affirmed)and subscribed before me of
V Physical Presence or Online Notarization Physical Prese a or Online Notarization
this_L da f 20 b�, this_1_�day ot PAAV'JCJV,, ,202 by
i
Name of person ma ing sta ment. Name of person making s/tatement.
Personally Known Personally Known ✓ OR Produced Identification
Type of Identificati " , KAREN S. NIELS Type of Identification
;.,aYP„e
Produced State of Florida-Notary Public produced "�--
ion # GG 207484
,
"'Eo F` My Commission Expires i�,.2o�Ai��a,, KAREN S, NIELSE
June 12, 2022tAfe Of Florida- N
I
(Signature of Notary Pu Ic- tate o on a (Signature of d[ �liq,-A "� `fPiOrf a�07484
',,,;, mission Expires
June 12, 20
Commission No. (Seal) Commission No.
REVIEWS FRONT ZONING TSUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 6 2