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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: C9 11 / — O N —C
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Building Permit P A L 2� 2a21 t Application ,U
Planning and Development Services St.t u0i
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982 /I�
Phone:(772)462-1553 Fax: (772)462-1578 (�
PERMIT APPLICATION FOR: W-�44 Clf�f 4r Yc
PROPOSED I°IUIPROVEMENT LOCATfON
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Address: 112 5C'1,-e-n C1 C4f/K V-- r1e__ 7Jr"r.(_,n§e4e-) /:;6PL C h
Property Tax ID#: Lot No. ly
Site Plan Name: Block No.
Project Name:
Q ETA fLED DE SCR�IPTIONt'OFVORK
IxAA s--V I Y
New Electrical Meter Second Electrical Meter 7
COlVSTRUCTIyON INFORIVIATIQN „
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator V/Roof g /L Pitch
Total Sq. Ft of Construction: 600 SF Sq. Ft. of First Floor:
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Cost of Construction:$ 00' z Utilities: —Sewer —Septic Building Height:
O1NNE;R/LESSEECONTRACTOR:. ,
Nam Name: &4L 9-• �
Address: 2 Lar,�e /
� Company: �'an ,i
City: �'L{i'n fA %�1 State:�— Address: ISO/ Sig. S. Al
Zip Code3gC)S9 Fax: City: _Pa4Si• Loticw' State:
Phone No. Zip Code:' 3g-9.r2_ Fax: ?72-33T7SSfi
E-Mail: Phone No 7?}- 335-9s5'0
Fill in fee simple Title Holder on next page(if different E-Mail I- UUlS @-CRkDI IUftL �co ryiig.com
from the Owner listed above) State or County License CCC 032S-/3
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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S,UPPLEMENTAL`CONSTRUCTION L-IEN'LAWrI°NFORMATIO°N: °
s �.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
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 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
vj*rre—n r or an attorney before commencing work or rec our Notice of Commencement.
Signatu Owner/Lessee/Contra or A ent for Owner Signat Contractor/License 4iolde
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STATE OF COUNTY OF �i�� COUNTY O STATE OF F
Swor to(or affirmed)and subscribed before me of Swof�to(or affirmed)and subscribed before me of
Ph s'cal Presence or Online Notarization ✓ P_hy sis�al Presence or Online Notarization
this �y of 2024 by thisbAay of :310 2024 by
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Name of person making st e e t. Name of person making st m nt.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Pro uced Produced
nat re of N ic- ate golmilto s (Signa ure N�. 'vblic-SteEd�JIQI
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MY COMMISSION#GG 9F,3418 _*r i,; MY COMMISSION#GG 953418
Commission No. '* " 9 2024
•�= IRES:Fet(fde�l,g � Commission �• �o`,: EXPIRES:February��@��
''•'rr,°Of+F;�Q` Bonded ThN Notary Public Underwrltors ,,•oFF��.,
Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20 =J