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All APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11 ( Permit Number:
( ��1� 1�
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:
PROPOSED IMPROVEMENT LOCATION:
Address: -11 I C-( S �--n j)c 6 l u ri- pi-Qr -Q
2C
Property Tax ID #: I ;X) - 120 11 " C0110, - on - y Lot No. _
Site Plan Name: �, �Block No. (02
Project Name: �kV Q5 r 0V -- -0of
DETAILED DESCRIPTION OF WORK:
m VQ f t e r n o 0 0 ►� 2e
1� na((_ -1Q Cow, l4CSz 5-Q1 G V4i CAA0(Pi(la�JA U
ao-r-
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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 X Roof �ZPitch
�\
Total Sq. Ft of Construction: 2-! S 00 Sq. Ft. of First Floor: �p V 0
Cost of Construction: $ 700 Utilities: -Sewer _Septic Building Height: )
OWNER/LESSEE:
CONTRACTOR:
Name J CL G \�1 C.
Name: (f ( C I S �O
Address: ) btu q k(- 611
Company: cos i6of mi *-•Q o KS 1
City: oI(i- -e If C-Q ilk State.
Address: iS'v% 54 .a-0
Zip Code: Ct S I Fax:
City: 96LkM C L t-{i State:
Phone No. E-
Zip Code: '3 K 9, cf d Fax:
Mail:
Phone No —l-)Z- $1S-to-CCr
Fill in fee simple Title Holder on next page (if different
E-Mail C -i s6s'(od'( I rY, (e tx I r ®q WZ4 l
State or County License�g�i
from the Owner listed above)
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.
R
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY:
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
_Not Applicable
UWNLK/ 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 jobsU before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before cofAm-eTitinia work or recording vnur Nntirp of t nmmpnrpmant
Signat re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA I
COUNTY OF ST C.-C.IC�—�
Sworn to Pkr affirmed and subscribed before me of
Physical Presence
or _ Online Notarization
this day of -Ir' 20 2L by
Name of person making statement.
Personall Known OR Produced Identification
Typ ntification Produced
(Signature of Notary Publli Statb-ofFlorida
Commission No. } `(�7( al)
NANCY HACIERHORST
Notary Public
State of Florida
Comm# HH167992
F>mlres 8/23/2025
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