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Date: 10 1 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
PERMIT APPLICATION FOR: R(5166'1-w ie. _ (O®�
PROPOSED IMPROVEMENT LOCATION:
Address: 314Z 1�0yi-h//Ir c\ t' I � (iej r. fioiI'T j (,,(re- LL�reclY.7 1
Property Tax ID #: `7 'IO z MO-1 0 ® — Lot No. JU
Site Plan Name: A 4 /� Block No.
Project Name: NOr\C~ A
DETAILED DESCRIPTION OF WORK:
OtAI(Xt Shi nO16 Co(anQ r
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
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
rI
(Affidavit required)
Generator
Sq. Ft. of First Floor:
Cost of Construction: $ 1 L° jo J Utilities:
Windows/Doors _ Pond
Roof Pitch
Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR::,�,,
Name
Name: r CO
! /
Address: /Q1j SW �tA £1Sy1
RV(--
Company: P-0
City: Ph r 11Ts/a in t W Gi e
Zip Code: ,3V /n Fax:
Phone No. v 2 —
State: �
E-
Address: 8 e5C� )
City: P(A?d0C I)I6( State:
Zip Code: _ Z5®_ Fax:
Phone No 722- L05 ` 3p 11 I'1
Mail: nLAO G ® 3ti'1 Z O k0a - com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail joh n6k (P n( pEtW I r
11GOM
State or County License CCC 13 Z(Do 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 LAW INFORMATION: I
NER/ENGINEER: g Not Applicable
Name: _
Address:
City: _
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name: _
Address:
City: _
Zip:
Phone:
State:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Not Applicable I BONDING COMPANY: [Not Applicable
Name: _
Address:
City:
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 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 ' bsite before the first inspection. If you intend to obtain financing, consult
withlende/ or an attorney, befoO commencing work or recording vour Notice of Commencement.
) 11t,
Si a ure o Owner essee/ ontract as Agent for Owner
S TE OF FLOJUDA
COUNTY OF ,�k^C✓�'1 `' I C�
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
thi 2 day of Q 202-' ( by
Name of p rson m ing statement.
Personally Known OR Prod ced Identification
Iden Type o tification Produced r�, t
ti r/I
(Signature of Notary Public to of Florida)
ICommission I I G(
eazpRYq sow "Notary '�'�Public i�
No. (Seal)
c 'State of Florida
i
Y Comm# HH041015
•s�NCE
I Expires 9/9/2074
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21