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All APPLICABLE INFO MUST BE COMPS D FOR APPLICATION TO BE ACCEPTED j Qj,�
Date: Permit Number:a IO(D'O Ull��
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:
Address:/I of 0 L. A- v' 1 vL- L^
Property Tax ID #: 9, �2d'" -01 -o oC1 oI Lot No.
Site Plan Name: Block No.
Project Name: TI C 7"yT f'GIL V 4' LI 66JCC�1q-
New Electrical Meter Second Electrical Meter,
(Affidavit -required)
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: b Sq. Ft. of First Floor:
Cost of Construction: $ 2-00 Utilities: —Sewer — Septic
Pond
Pitch
Building Height:
a
t?WNER EESS PE
Name '
Cat �
Name: LEO
c�C�, i'
Addreesss: UUl 51 C CM: _���. =' `•
Company: n/uyi/I Yd'Ik1�cr�S
Address: SSd
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City -t- 1�C�'- . ........_... __. ,.:. .::State-�'J
Zip Code: ;>�( C1 t'J Q Fax:
Phone No. Us ()
City: 1i4( State:`/
Zip Code:?-OKA _ Fax:
Phone No
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E-Mail c J,S(X� 1 M u , CGYA
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailloniy I' r44y-1 hcriS
State or County License % lam/' (a 6AV
If value of construction is 75UU or more, a KtLUKUtU IMOUL& ui
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: _ of Applicable
Name:
Name:
Address:
Address:
City: G (CT State:
City: State:
Zip: Phone 5% I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: bzKot 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
in
which is 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 q_rLattprney before commencing work or recording -your Notice of Commencement.
Signature ner/ Lessee/Con r as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swor to (or affir ed) and subscribed be o e me of V Physical Presence or Online Notarization
this day ofJkq 2 by
V 1w 6_�
Name rson making statement.
Personally Known
OR P�r idu d Identifications
Type � 1,
ofNentification Produced
{Sig a Notary Public- State Florida) •�.,,
;fit • '°�; ; �NAFiMAINGRAM-RAHNNMG
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W =*N#GG2750S3 i'
Commission No. (Seal) ; EXPIRES December
pp 20, 2022
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• y' •.°lit° � Bonded Ttnti Notary Pubac Undenvrilt;J''
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