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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: �`' , �� Permit Number: 1
O RECEIVED
p ° Building Permit Application SEP VO 2021
Planning and Development Services St.LucoAounty
Building and Code Regulation Division Commercial Residenitlal Perpn9
2306 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
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PROPOSED IMPROVEMENT LOCATION: .
Address: 7 �fO S.��yu � � . t O ►2�2C ti L Property Tax ID#: / 0 7d / ' D 00 Z Z Lot No.
Site Plan Name: Zy,--t- Qe.-k Block No.
Project Name:
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DETAILED DESCRIPTION,OF WORK:
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New Electrical Meter Second Electrical Meter (Affidavit required)
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CONSTRUCTION INFORMATION:
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 _Roof Pitch
Total Sq. Ft of Construction Sq. Ft.of First Floor:
Cost of Construction:$ 0& Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: ,, CONTRACTOR:
Name
Name: air
Address: _5_7/ Company:-112,6 .y�t Zow
City: %T. Q,"es L C +— State: /'/ Address: 2,0e4 !q-i�ww
Zip Code: 3 Fax: City: State: /—
Phone No. 79 2 2-2 7 E- Zip Code: 3!�{9Itf"? Fax:
Mail:_ '_Vd Phone No 7 9-- X 2 e l ^ ZA 4e
Fill in fee simple Title Holder on next page(if different E-Mail art `t i,yAl'c_ L-0 _Z (A 'ye
from the Owner listed above) State or County License C C-C O3GO yl
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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SUPPEEMENTAL_CONSTRUCTION LIEN LAW INFORMATION:
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: i _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 conflicts with any.applicable Homeowners Association rules,bylaws or and covenants that mavlrestrict or prohibit such
structure.Please consult with your Homeowners 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 attorney before commencing work or recording our Notice of Commencement.
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Signature of caner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Sir_Ly c\t
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
th is� day of Sa 208.E by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced \--
(Signature of Notary lic-State of Florida)
ENS
Commission NoAk%6Aa'JS Sao..•°� DEANNAGIVeof
.Notary Public-State of Florida
V� Commission#HH 086359
i.!nded
M Comm.Expires Jan 28,2025-
y Assn.
through National Notary
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