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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a1. Permit Number:
RECEIVED
0) _ SEP 02 2021
Building Permit Application ry
St.Lucie County
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
PERMIT APPLICATION FOR:
PROPOSED IIVIPROVEM.ENT.LOCATION: ` d
Address: ?)W NGrUn'1Q Aw--, Ps L 3411 g"�
Property Tax ID#: 3,,-A I C —S: 10 oaSS —000-S Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:.. F '
'tjk AUrin around a irV-i nc4 CLreari
CD
u '
n to t w i l l �32, Sri% %k , x P-nd eS
New Electrical Meter Second Electrical Meter (Affidavit required)
CGNSTRUCTION INFORMATION. E Lit
�a>F�.
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 of Construction: �1 '~$ � � . Utilities: _Sewer _Septic Building Height:
OVIIN ER/LESSEE`: CONTRACTOR
"� 1 e 06 Yl Nam C..h
Name u -�.
�QV.k. O
Address:13� kA- Mkr'aril0, Av-2, Company:Sic' Lpn(x.ems 'Pws
City: State:�l. Address:2aRQ G-re�rtYlLlriyl
Zip Code: SgC19 Fax: Nla City: State: IFV
Phone No�1 - wcl!5S Zip Code:3u CA 21 Fax: k\.)\)A
E-Mail: qJ I Phone No "12-211A y3�10
Fill in fee simple Title Holder on next page(if different E-Mail,\'C12. (-0nCX- X 'JR10S ' ao\ •cooci
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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'�`�PPL� E�1il� L �s��'6 ��C�F� ; iS A�%�� � �•s� � h'�i^, �p',� is �� +�- 3�Y6't' �� .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: ��, Not Applicable .
Name: Name: 'I
Address• Address• 11
Gty: State: City: ! State:
Zip: Phone Zip: Phone: II
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: I Not Applicable
Name: Name:
Address: Address:
City: City: �I
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
1 certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is grantin a permit will authorize the permit holder tlo 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 Amendment's. .
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-residentiai 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 Coun nd osted on the jobsite before the first inspection. If you intend'Ito obtain financing,consult
with lend or attorne before commencing work or recording our Notice of Commencement.
Fig—natuD6 of owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF .
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this lik day of of .20 a_% by
Name of person making statement.
I
Personally Known OR Produced Identification
Type of Identification Produced L,, i
(Signature of NotafW4j ate of FWdOG►VENS
Notary public-State of Florida
Commission No. r• om�ission=HH 086359
oorn .Expires Jan 28,2025
Bonded through National Notary Assn.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21
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