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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
11 (j���- �2 RECEIVED
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L U o _`- ' tin
Building Permit Application Ae SttLucie Count epart,ent
Planning and Development Services.
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982-
Phone:(772)46271553 Fax: (772)462-1578
PERMIT APPLICATION FOR.:
PROPOSED IMPROVEMENT LOCATION:
Address: & E,d I L UGC( C_
Property Tax ID#: 4 115 501 -003-1 -61C3—2L Lot No.
Site Plan Name:—. Block No.
Project Name: 6kX'cn,
DEETAILED'DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional workto 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: $ 7,006, OCR Utilities: —Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name 1 y�'Ur. £r• g L� �-�I�,z;�a .��0. Name: Al e*"
Address: 14' f0-,z;Jk 6.P,sv, Company: .
,City: ue r a,.,,g State: �y Address: /7q0 ,4/( l &--e
Zip Coder,-7 9' 6 ' Fax: City: we54 t1g 4v, &CJ- State:.
Phone No. Zip Code: 33 y0-7 Fax: 6/-? - %d 77 9096
E=Mail: Phone.No Q1j_gQ7" 9 00?
Fill in fee simple Title Holder on next page(if different E-Mail ng�r, Au, �S r40 L
from the Owner listed above) State or County License 000070 aa<7 .
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC Is$7,500 or,more, RECORDED Notice of Commencement is required.
47
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE BOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: 21
Address: ,tN Address: IrY
City: 11 1City:
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 attorney before commencing work or recording o Notice of Commencement.
4 Z
F- "u �✓
Signature of Owner/Lessee/Contractor as Agent for Owner Signat a ntractor/License Holder
STATE OF FLORIDA STATE OF FL IDA
COUNTY OF COUNTY OF 1VY1 WQ&-)
Sworn to(or affirmed)and subscribed before me of Swop to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Phy,s,ical Presence or Online Notarization
this day of 2020 by this LLD—nay of by
Name of person making statement. Name f person making statement.
Personally Known OR Produced Identification Personally Known .,k OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida) (Signature of(Votary Public-State of FI I lug,
ti R °�8�:,. MARIA C PM IA
?4''" Notary Public-StateFlorida
Commission No. (Seal) Commission No. i; Commission#GG 9 i044
7; oFR My Comm.Expires ul 9,202A
NatiaRal o ry Assr IWMW
REVIEWS FRONT ZONING SUPERVISOR PLANS 'VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
CALI1,, RNIA CERTIFICATE OF ACKN. JUDGMENT
A no tar, ublic or other officer completing this certificate verifies only the identity of
t in
dividual
he In vdua I who signed the document to which this certificate is attached,and not
the truthfulness,accuracy,or validity of that document.
State of California
Countyof
5
On before me, sqyec PuUIC,
(here insert narric and title of the offiled
personally appeared
who proved to me on the basis of satisfactory evidence to be t ersonk4whose namewaare subscribed to
the within instrument and acknowled ed to me that In sh /they executed the same in hisQ�their
authorized capacity, and that by his§1he /their signature on the instrument the persona,
or the entity
Wri
upon behalf of which the person(yf acted,executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the
State of California that the foregoing paragraph is true and correct.
R.SPEER
0
COMM. #2344810 Z
Z: o Notary Public-California
San Bernardino County 0
y Comm.
P—fires—Feb.n D
WITNESS my hand and official seal. M
Signature (� � �(,Q,b`�
(Seal)
.............
Optional Information
Although the information in this WC0011 is not required by law,It could prevent fraudulent removal and reattachniont of this acknowledgment to an
unauthorized docurnent and rnay prove useful to persons relying on the attached document.
Description of Attached Document U 0M 'k
M-.? "
The preceding Certificate of Acknowledgment is attached to a document Method of Signer Identification
titled/for the purpose of Proved to me on I basis of satisfactory evidence:
form(s)(if iirfq-mifiration credible
Notarial event is detailed in notary journal on:
containing pages,and dated Page H Entry 9
The signer(s)capacity or authority is/are as: Notary
Individual(s) Other
Attorney-in-Fact
Additional Signer(s) signer(s)niumbprint(s)
Corporate Officer(s)
Ti(lh�b) LJ
F1 Guardian/Conservator
Partner-Limited/General
❑ Trustee(s)
Other:
representing:
Nariwk)of Nrion(i)or II Signer is m.-piesentiticl
I opyr-Ot 2001 2016 11 Rotary,110 flo,-11,100.0,?s Mom,,,,IA U. 31 1 0507 All Right,ll,ne,ved It,-n,Numb-1 10171.1 Ilit?,ise(ontact your Awhowed Rr11,!f to jm(,haso 0 this fl)'Hir