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All APPLICA/BL INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `�
Date: {0 A- %Z Permit Number: r
g = ' Building Permit Application
Planning and Development Services
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:
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Address: ! 2n Cvo7 r
Property Tax ID#: O ` . --�00Ir �1� Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required)
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Additional work to be performed under this permit-chock all that apply:
<SMechanicalio� _Gas Tank _Gas Piping _Shutters .Windows/Doors - Pond
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_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 70o Utilities: _Sewer ;Septic Building Height:
Name ► ie-✓e e Name: �A7 (/r ee_
Address:Ilf2-%J 69,C L,h Company: b U/rer- .1 G>G �7 �6° ✓/!G,
City: /Pq- U'e2rC.e State: Address .� &U /07 J
Zip Code: -?(r- Fax: City: )r -Stir e teL State:lt-�
Phone No. 6 572 " 6 C( Zip Code: -?2-5T Fax:
E-Mail: VS 3r vi.r-y 9- d� �yY►�r,�/ie Phone No 7 72 P 1
Fill in fee simple Title Holder on next page (if different E-Mail /n.� c le Co DO Carl
from the Owner listed above) State or County License CSC/8 U3
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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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: Stater
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 holderto 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County a d posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with I n er X/an/fittorney before commencing work or recording our Notice of Commencement.
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Sig ature of Own Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF S� l,v►: C�--
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this Q; �day of 29A by
` 1inn
Name of person making statement.
Personally Known OR Produced Identifica},oon
Type of Identification Produced ° 'V
U
., PG�i AUGHN
{Signature of Notary Public-State of Florida) ,o`I y °o-
�r " °_State of Florida-Notary Public
Commission # GG 270079
Commission Ex i
My res
Commission No. (Seal) °PP ®
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev