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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: ..� L �D ` Permit Number: C;? 1 Li_- DL(L
o L�(ZULe-
OCT 15 2020
Y-1- 411St. Lucie COUnty
°� `-� ° Building Permit Application Permitting
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:
�P)tOPOSED IMPROVEMENT LOCATION °�� � ,, � x Y w= � ,� � z � • ,a,' _ �, t �� � � ��
Address: 4&flb 4 fln,,'-A. ' 4) a.1
Property Tax ID #: .fib 1 ? — D.Z/ Z � �D�/— `i Lot No.
Site.Plan Name: Block No, y
Project Name:^�c�et
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 _ Pond
_ Electric ;_ Plumbing _ Sprinklers _ Generator —Roof Pitch
Total Sq. Ft of Construction: /�%� Sq. Ft. of First Floor: AgWrQ,c es®
Cost of Construction: $ _��� r9 fl _ �''� Utilities: —Sewer —Septic Building Height:
,,,
CONTRA R
Name ,, .- L44-e_ IeC .X_,W
Name: / �A
Address: 4,,S—�
Company,:
Address:
City: . ,�� P �-�,L State;
Zip Code: ' 3fJ-7 Fax: /ii/ice
City: State:
Phone No. 7_7o2_- -- V Xa -- „z / c3—o2— E-
Zip Code: Fax:
Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License
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.
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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
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.
Thefollowing 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 attornev before commencine work or recordine vour Notice of Commencement.
VStuzr&e�ofowner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 54- L �)
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this L day of . 20 Z(by
Name of person making statement.
d
Personally Known OR Produced Identification
Ty a of Identification Produced jj)� _
(:nQ Jai
( ignature of Notary Public -St of Florida)" ,,ai�u, HEATHER BURFORD
PUg'�'
. p�Pa
s
r _,State
- tate of Florida -Notary Public
Commission No. (Seal) "E Commission # GG 183217
My Commiasion Expires
I°ebruary 08, 2022
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