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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S / y/2) Permit Number: "--W) a3a
RECEIVED
Building Permit Application S4 '"Woo qgynwv
Planning and Development Services I�ISPPPII. no
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:. �Q
PROPOSED IMPROVEMENT LOCATIIONt-
Address: c—l4;b; SC wS poi'
Property Tax ID #: 13 0 &o ,S7- - n of 00 - 000 Lot No.��
Site.Plan Name: LaKe' woof T:Lr A . owl S` .. Block No. Y7
Project Name:
DETAILED DESCRIPTION�OFWORK:
i Gl C1 2 UM. ki S -in Z i l e- S- c- %J ("1 A 2 Slr►.:� ( n /' n h rc--4n P V_'.r A
New Electrical Meter ✓ Second Electrical Meter
CONSTRUCTION INFORMATION:"w:
Additional work to be performed under this -permit —check all that apply:
✓Mechanical _ Gas Tank _ Gas Piping _ Shutters ✓Windows/Doors _Pond
✓Electric VP'Iumbing _Sprinklers --Generator- V�R_oof Pitch
Total Sq. Ft of Construction: 7 U l Sq. Ft. of First Floor: -10 q
Cost of Construction: $ 0Oc5[) Utilities:- _ Sewer.. ✓e.pti.c Building Height.
OWNERAESSEE;
CONTRACTOR,a
Name Lucia 1AA—,W �or Puw,&,
Name: S+ � L.ci-t Ro bJ" y ar
14 t ftrW_ t
Address: 702 S. (o
Company:
City: FJ . Q; crc e State:
-Address:. i02
Zip Code: 3cl I CO Fax:
City:
State:—C-_C,
Phone No. '772-
Zip Code: 'NU-0 Fax:.
E-mail:
Phone No I ?,D - c( 614 -11 1 7
E-Mail
Fill in fee simple Title Holder on next page (if diffe ent
from the Owner listed above)
State or County License -.SS $ry
(t
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.
SUPPLEMENTAL CONSTRUCTION ,LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
t Applicable
Name:
Name: S1.
_
Address: y Lj s-I S• .Lac;
% blvj
Address:
City: rml, Q; trc.c
State: )=L
City: : z
State: ELI
Zip: tLi q c! 6 Phone_b-1a1
Flo q- 1 ®o 3
Zip: Phone: '7-7'X—L[6gLJ
II.7
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 attorney before commencing work or recording vour Notice of Commencement.
Signatkre of Owner/ Lessee/Contractor as Agent for Owner
Signat re of Contractor/License Holder
STATE OF FLORI A
STATE OF FLORIDA
COUNTY OF WCi e
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
SvVjn to (or affirmed) and subscribed before me of
fl hysical Presence or Online Notarization
iU hysical Presence or Online Notarization
this day of QCrCQ2Gf,. 2024 by
this day of 0MOP-'0W�— 204 by
_Jk1ilu 7)a W LD� 7�4
(1JAW (X )0
Name of person making statement.
J
Name of person making statement.
Personally Known OR Produced Identification
Personally Known )0 OR Produced Identification
Type of Identification
Type of Identification
Prod cr'
Produc d
ure o Notary Public- State F;R PaB� . TONYA R. Lga ` o N ry Public- Stat ��, , ,, TONYA R.
MI.
Notary Public-sta a of Florida ?:°��rPu��� No ry Public -State o
Commission No. =.
��% j Commission # G(Y��►igsi No. .f ��5 ' ®$e@ mission # GG
MY Commissio Expires M Commission E
October 01, 2023 '�.�,piI��°�� Y
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.576720