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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O�a Permit Number: °-,d�" J'�5d
ST. LUCIE
F L 'O .R .I
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
RECEIVED
SEP 2 2 2021
St. Lucie C my
Perm g
Residential
PERMIT APPLICATION FOR: C� rl 5+qp —er AJ C1nb4 r r\/
PF OPO`SED tMPRQ�%EMENT;C(%AT(ON
Address: '3 �� 5
Property Tax ID #:
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof _
Total Sq. Ft of Construction:
Cost of Construction: $ q 0, 0,
Sq. Ft. of First Floor: _
Utilities: —Sewer _Septic
Lot No.
Block No.
Building Height:
Pond
Pitch
ONTRMUM '�� f �,
Name 14" `o- 160L" •2
Name:
Address: L 6� St°�c �v%may
f{.,�,.srs itol
Company: -)
Address: c
City: CJ
Zip Code: df>
Phone No
VLx
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State:
Fax:
City: FT /�,'<.-c c State: F/,
?ip Code: Fax:
Phone No. 7 1 s
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License ' -6 a
It 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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�UPPLEl1/I��{'+"�L ��,' RUL�O°� 1.1 l� '"�Ri'
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
` Not Applicable
BONDING COMPANY: Not Applicable
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 Ipnripr nr an attornpv hefnre commencine work or recordini? vour Notice of Commencement.
Sign ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORI
STATE OF FLORI A
f
COUNTY OF -� LA )rie
COUNTY OF f
Swo to (or affirmed) and subscribed before me of
Sw�ornVo (or affirmed) and subscribed before me of
Notarization
Physical Presence or Online Notarization
y Physical Presence or Online
thisnl�7� of 202J by
this a r of 2024 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification _
Personally Known OR Produced Identification
Type of Identi icatio /
Produced 5 0 Ie I of
Type of Identification
Produced o
I
(Signature of Not y Public- State of Flor' a
(Signature of otary Public- State of Flor' a)
Rebekah Hoy
1 y�, Rebekah Hoy
Commission No. J NOTARY PUB
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ICommission No. o� NOTARY PUBLI
- STATE OF FLOI
STATE OF FLORIDA
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