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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:' 1� Zl Z' Permit Number:
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:
RECEIVED
APR 21 2021
PQrmitti�ng Departm
[ ucie Courrty
1 PROPOSED IMPROVEMENT LOCATION:
Address- 4Q.79-
Property Tax ID#1-53(o'411-0060,-&VO ( Lot No.
Site Plan Name: Block No.
Project Name: W5fya.{ CO k l v V
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION' INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
tel: ctric numbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ S 10160 Utilities: —Sewer lSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name t C ®1 typl\
Name: -,r_ 666h S ,
_VAisSt
Address: clp-7 °I k444^-
Company: 5-S �A- v Mtn
City: � aei'Ce_ State&L
Address: Q v 7 CPA- C.1-
City: , ,—Oiyr, be PL-a' State:-E—L-
Zip Code: ,7)!J 9 Li (0 Fax:
Phone No.
Zip Code -1-0tU --) Fax:
E-Mail:
Phone No-772--�?q _ ?,Sq
E-MailQnLrW54&A ICJ 3 7(D C,j"-&' I • Co�^'�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License to
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 LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: i✓/— S i AL FvtA LrLzeAtLewName:
MORTGAGE COMPANY:
_` 9—oot Applicable
Addr s : 131 1ee- e_
Address:
City:State:
City:
State:
Zip: =9 Phone
Zip:' Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY:
-L,,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 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 attornev before commencing work or recording your Notice of Commencement.
.~
kignhture
UV
of Owner/ Les a/Contractor as Agent for Owner
Signature Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF &t. L,,, c,ie-,
COUNTY OF 9
Sworn to (or affirmed) and subscribed before me of
Swor o (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
Physical Presence or Online Notarization
this 2-7 day of Mc ec, ,:8:19 by
this � day of A/)urn , 210�261by
.Zoa i
q"[iSSa. caf f.
° � a0a.l
CIUSt�g ��sl•.bo.,�w.
Name of person making statement.
Name of erson making statement.
Personally Known OR Produced Identification '/
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced :VuS `ce^Se-
ProducedVQs L:cer.Sc,
AtEXA KRATT
��,,jntuyof Florida
" Pa Ai;'cXa !M7
e'"
(SignatU o otary °e ofQ�o !&*P # GG 984139
'•.,,,oFF`4; My Comma Expires May,4, 2024
(Signature o tary i 'te of r,[dar}; GG 984139
Bonded,throug a naVNotaryAssn.
Commission No.
,oFF° MYComm.•E of;Es'+.a ;4,3024
Commission No, Bonded through �r�3�M` notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20