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All APPLICABLE INFO MUST BE COMPLE I ED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Corl'Inler'dal Rdsidential
2300 Virginia Avenue, Fort Pierce FL 349821
Phone: (772) 462=1553 Fax:. (772) 462 '1578
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PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:.
Address: �0;( to I'll 8'..
PropertyTax ID #: Lot No.
Site Plan Name: , 'u L l� i `s-` l Q. , � Q_Block No. _
Project Name:
DETAILED DESCRIPTION OF WORK:
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A ■ \ I I ./I !l-TTC�T�'L c • ■✓C. D Ckems/ V ° Y Ct �n l
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank I _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric —Plumbing Sprinklers Y - Generator-- _ Roof Pitch
Total Sq. Ft of Construction: 5-6 Sq. Ft. of First Floor: .
Cost of Construction: $ -c-zo Utilities: —Sewer —Septic Building Height: t
OWNER/LESSEE:
CONTRACTOR:
Name 1l'Q"(� i=(�
Name: lad
�5(l.
Address:
Company, 1 l ":
Address
ccs'n5
City:CState:
Zip CoderI.S�Z==M Fax:
City: -I -k ,�►c'�2CL�
Stater
Phone. No.
Zip :Eod'e''t`3.�%'
Fax: `
E-mail:
Phone No 22 S'i?
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Fill in fee simple Title Holder on next page ( if different
E-mail
from the Owner listed above)
State or County License �n0�
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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',,,SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMAT,IOW,
DESIGNER ENGINEER: T
Name:
Not Applicable
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MORTGAGE COMPANY: Not Applicable
Name:
Address: J(o W
v ^
Address:
City:`
State:
City: "State:
Zip: '�,.I Phone —
—
Zip:,, Phone:
FEE SIMPLE TITLEHOLDER: _
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 restriction's 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 iri-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. lein r n attorney you before or recor ' Notice -of Commenc�me� , -
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Sidnatarlfof Owner/ Lessee/Mrft ac-to s Agent r Owner �ignature—f Contractor/License Bolder J
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Slr . Lye a COUNTY OF
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
-Y Physical Presence or Online Notarization x Physical Presence or Online Notarization°•:
this %aday of O 1-+ . , 2020 by this a. day of 2020 by
Name of person making statement. Name of"person making sta meet.
Personally -Known OR Produced, Identification Personally Known OR Produced Identification
Type of Identification . Type of Identification
Produced V t- D duced VV {\' L_
Commission -No. c_<,o-a-
REVIEWS FRONT
COUNTER
DATE
RECEIVED - -.
DATE
COMPLETED
Pb, EXPIRES: Decernber f6,,2020
Bonded Thrtr Notary Public UnderwAt
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REVIEW REVIEW I REVIEW
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Bonded Tltru Notary PubQc Underwriters
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