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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED G�
Date: �� Permit Number: c,2&.2
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BuildingPermit Alication
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Planning and Development Services
Building and Code Regulation Division Commercial- Residentia4Ul 9 S
2300 Virginia Avenue, Fort Pierce FL 34982 Permitting L)epartrne Phone: (772) 462-1553 Fax: (772) 462-1578 St. Lucie County nt
PERMIT APPLICATION FOR:
BPR*O`PO�SEDMP.�ROVEME�NTLOCATION
Address: 7r&be.JC4 �Anhlil`�tq , Jbaq �5
Property Tax ID #: 2 `t z. Vt> nr FJUU/ fJUU� Lot NO.
Site Plan Name: L'e74/ _bese, G 00: A" /t60 Block No.
Project Name: (Gvl A- Vl
New Electrical Meter Second Electrical Meter (Affidavit required)
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CONSTRUC�TI £ N> INFORMATION w
_
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping — Shutters _ Windows/Doors _ Pond
_Electric I _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 30i Ode -
Generator I _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNErR/LESSEE
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CONTRACTOR
Name PA .91MA V1 66L
Name:
Address: /S I�S�ns b>�lV � S%;
Company:
City: �O�W-/ 1�1f5,
State:i7i
Address 0'3b CIDij
Zip Code: I Fax:
15
City:
Phone No.
Zip Code:,!M (�� Fa'x::
Phone No
E-Mail:—
Fill in fee simple Title Holder on next page (if different
E-Mail zyo A
State or County License�l�
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.
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S.U'PPLEMENTAL CONSTRhJCT1,0`N LfEN` LAW
INFOR'IMATIOIV
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DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: of 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 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.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attDmey before commencing work or recording your Notice of Commencement.
Signatur 0 er/ ssee ntractor as Agent for Owner
STAT F FLO DAB .
CO U TY OF �...�• — C) q__
Sworn to (or affirme�d ^and subscribed before me of Physical Presence or Online Notarization
4
this S• day of J ,�Q� 20 2% by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identificatio Pr duced
(Signature of No of Flori )
L i4,Iic-Sttate
Commission No. t7 U3��5 (Seal) ANNARELLAACCION
,•ot►sLYO�•:
? • �s Notary Public - State of Florida
�.Q`s Commission # HH 038085
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My comm. Expires Aug 31, 2024
Bonded through National Notary Assn,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED.
Rev 1
EXHIBIT "A" PRIMA VISTA CROSSING LEGAL DESCRIPTION
The North 442.78 feet of the South 2,385.78 feet of Southeast'/a of Section 22, Township 36 South, Range 40 East,
Lying East of US Highway No. 1.