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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n n
Date: `'I N U Permit Number: �J V�'
RECEIVED
MAR 3 1 2021
Building Permit Appiicati®
ermittirtg Dapartmen,
Planning and Development Services St. Lucie Counh,
Building and Code Regulation Oivision
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
FFEERMITTYPE:
Address:^�7�� SuvLS�} �1vcQ t,SLlZ47.8a
Property Fax ID #: �(�� _ (9 / ®� � p�� ' 6 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:' ;.'—Ro_of.-: Pitch
Total Sq. Ft of Construction: _ ��� `'^ Sq. Ft. of First Floor:
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Cost of Construction: $ 'Z,3� , �g Utilities: Sewer Septic Building Height:.
„y yi• F,
Name Chas rAS� �- Name:
Address: 5 Company;
City: State:4 L— I Address:
Zip Code: 3 q98 Z Fax: City: State:
Phone No. —7"1 Z 3("l g20(o Zip Code: Fax:
E-Mail: �o_Sp�c� G S �0(� i �J ;�c�1100 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 MORTGAfiE COMPANY: _Not Applica ble
Name: Name: C_.J"oSS
Address: Address: �—
City: State: City: State: 0 k
Zip: Phone Zip: L4 4tq) Phone: 5:/7-7 3Se 3L)oc)
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 PAY11MG
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
PO ED ON THE JOBS E BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
W 1(bU'R,LEN OR ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signa o Owner/Le /Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO RI DAO I STATE OF FLORIDA
COUNTY OF 7 ' 1 �') I' COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I day of ,20-21 by this day of 20_ by
C-4a2;IrT-
1im6c -
Name of person making statement. / Name of person making statement.
Personally Known OR Produced Identification J Personally Known OR Produced Identification
Type of Identifi Type of Identification
Produced Produced
(Sign ture of N - (Signature of Notary Public-State of Florida )
SM1�Y PUS AUDREY B.HUMPHREY
Commission No. MYCOMMISSI(g aljFG330817 Commission No. (Seal)
EXPIRES:i'darch 6,2023
Bonded Thru Notary Public Underwriters R
k ter-.,, --•msa-�-.ss^�:a.rex,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW I REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19