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All APPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l 1) ^-
Date: �' 1 Permit Number:
b RECEIVED
Building Permit Application
Planning and Development Services MAR 1.9 1021
Building and Code Regulation Division Permitting,Dapartmen
2300 Virginia Avenue, Fort Pierce FL 34982 Lucie county
Phone:(772) 462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT TYPE: -,�
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Address:_—, rl�T CCU /��/• ��' eO�G� ._� Cr :. Lj ��Z
Property Tax ID 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: Sq. Ft. of First Floor:
Cost of Construction: Utilities: _Sewer _Septic Building Height:
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Name; l?rr ,S L7uJa,(` ZI ✓I•'o r6
Address: .. G r, C�� Qdmps6y: Q G,, e �(r✓} �1'7CcNCE'
:.City: _ �j`�<C� State:•rL Addr.es's:/.
' Zip Code: 'r{ Fax: City: l/er0 State: L
Phone No. 77,2 ` c�32 � Zip Coder37 f C 2+ Fax: /V�
E-Mail: �i�OeF> S�( t, e�Zo Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail ' wa r' , CCO/7
from the Owner listed above) State or County Licenset d 5 86 2
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 Applica ble
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 III 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
XITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
MENT."
41igture of Owner/Lessee/Contractor as Agent for Owner Signature of o tractor ice se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S. UAC.ie COUNTY OFSA • LL4ci
The forgoing instrument was acknowledged before me The for of' instrument was acknowledged before me
this I Ci day of Rcv c1h 2011 by this I Pday of LI tCb 20 21 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification_ Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced J)f Li i CevxS1'_ Produced
i nature of Not Public St e;gl;�4l�r�yda uHRISTfNA CAS �n ure of Notary lic- at. Y-' I -id�IjIR1STINA CASSE
rA,Notary Public-state of Florida ,_ :Notary Public-State of FI n
ommission # HH 1 �-
Commission #HH 212 0
2���� p� �NZj2�() oa 8ommission Expires
Commission No. o ea ��� ssion No.
y Commission Ex Tres ;�F`��
t
July 31, 2024 '""` July 31, 2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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