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All APPLICABLE INFO gMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date : ( O S 11 Permit Number:
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 CBDG Funding
PIRMITAPPLICATION FOR :
At
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Address: Ll7 ( S CAI . RWJ AtA t +0 PktrCk, P( . 3149q �
Property Tax ID #: IIL4 121 ^ I Z O ' 00 1 q m 0C7C) I Lot No.
Site Plan Name : AA v` Ci 'e n i () Block No,
A Project Name : r" CB .Q_ yl 1 0
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New Electrical Meter Second Electrical Meter (Affidavit required)
NINE e w- i
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 o$ff Construction : $ I 6 J Utilities: _ Sewwer Septic Building Height :
AMR
Name Vtv r C ! .Q- rtVO Name : cmret Cwidlcuz
Address : 21 �5y; N • 1+ W ` J Al, N Company: Corntie6-e `� \ ech- c lNe •
City: CrC.g State: Fl . Address:j31 Sebas4-on BIVCAO
Zip Code: �L4 Fax: City: Scbo0 s `ryo. y State:
Phone No . III ® E.0 2 ( 52 03 E- Zip Code : 23 "L of 5 13 Fax:
Mail : Phone No I I I ' 3bg 33
Fill in fee simple Title Holder on next page (if different E-Mail ck 0 .0 c) evA s 6 e i ✓i P C ompiv 8e < Iec h-j e ® co
from the Owner listed above) State or County License C, 0c> 0 19 1
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.
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 I....
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict 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.
Signature of Owner/ Lessee/Congas-Agent for Owner
STATE OF FLORIDA
COUNTY OF — F ctt C�l a \ 0iV C V '
Sworn tp((or affirmed nd subscribed bef r me of Physical Presence or _ Online Notarization
this day .rM 2orby
6 Ck. re�t � C d ✓z l
Name of person making statement—
t/
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- tate of Florid
vi oo COURTNEY E REGAN
M C � � Notary Public - Stat of Florida
Commission No. 1 V Ld l( eal) '��t� Commission U HH OL8294
'.F,or�FY°p My Comm. Expires Sep 19, 2024
Bonded through National NotaryAssn,
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