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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 101— 00
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Date: 7'i'�) Permit Number: AunopGIOM iS
(�Iro GGA LOT C).a— aoz Z o Inr
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p:w-<-� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential 1/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
`PROPOSED'I'MPROVEMENT LOCATION
Address: )ZLI&I Nw NIAOINCIL r al
Property Tax ID #: — -6 Lot No,
Site Plan Name: 1 e_ Block No.
Project Name: AlWz
DETAILED DESCRIPTION,OFWORK
2A�s , .s cAz t;�AE*9-e
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
/Electric _V Plumbing _ Sprinklers _ Generator 1✓Roof Pitch
Total Sq. Ft of Construction: AO OA Sq. Ft. of First Floor: 332$ IC
Cost of Construction: $ 0M Utilities: V Sewer _ Septic Building Height:
OWNER/LESSEE..:
CONTRACTOR:::. "
Name MjZ A
Name:
Address:
Company:
City: . State:
Address: K
City:
State:
Zip Code: Fax:
Phone No. 2h 1 -660 -Slogb
Zip Code: M1 !`T
Fax: 77Z,,2�yj-���7
E-Mail: L- NoDe-a 0 ,6HAI .
Phone No `77 1 a
Fill in fee simple Title Holder on next page ( if different
E-Mail 1
from the Owner listed above)
State or County License
CGIA
2
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 LAUV INFO.RMAT,ION
DESIGNEg/E
Name: i` 1
Aciclress:fl
City:
Zip:
GINE R•
4 �
12011
14iL
Phone
of Applicable
State:
-
MORTGAGE COMPANY: Not Applicable
Name:
Address:
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 Count 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.
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with Lander or an attorney before commencing work or r cording our Notice of Commencement.
S gnature of Owner Lessee/Contractor as Agent for Owner Sign t r f =Contractor/LicenseSTATE OF FLORIDA STA OF COUNTY OF i%) 4� CO TY O
Sworn to (or affirmed) and subscribed before me of Swore rn to (or affirmed) and subscribed fore me of
✓Physical Presence or Online Notarization �/ Physical Presence or Onlin Notarization
this & day of YhRY-C � 202P by this day of 020 by
/-OL(/s A A-Iclfeo
Name of person making statement. Y Name of person making state ent.
Personally Known OR Produced Identification /\ Personally Known 1"' OR Produced Identification
Type of Identification Type of Identification
Produced T)L„ la!) Du Produced
(Signature ofVlary Public- ignature of
aeor •� Notary Public State of Florida yr'" N� Notary Public State of Florida
Commission No. IIyyl�y�� Allen mmission Nc z f MaryMAllen (Seal
s Nf C"orfim/ ion HH 045562 ,•, y�ommission HH 04556
of,,df Expires 09/23/2024 aL ' Expires 09/23/2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.