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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application, 1�0
Planning and Development Services ��i1Diy
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:
$ j�
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Address: �� Z 0 S -�/� 41 ✓ 1) X I eftG9 3 V16-�
Property Tax ID #: l 31 3 5-0Z - 0 Uyt - 0 U d Lot No.�'��
Site Plan Name: � &d- L6 Block No.
Project Name:
DETAILS DESC IPT10N CrF �1► }R k `n 6 s
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUOTIO IIFORIIATI3N k
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Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters 7X- Windows/Doors _ Pond
Electric Plumbing _Sprinklers _Generator 4 Roof Pitch
Total Sq. Ft of Construction:g4 Sq. Ft, of First Floor: �y
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Cost of Construction: $ Z�J Q, Ol7d Utilities: Sewer —Septic Building Height: _
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Name IW17`/7 4-
Name:
Address: 7_ (% ��G� d;v
Company: ✓ GUIA 6) �! S
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City: /�r �iInee- State:
Address: 51 l %/!� ion- z��'
City: I .e-LU State:
Zip Code: Fax:
Phone No. I SJ' `l `� I ri b E-
Zip Code: �3 ZJ /54 Fax:
Mail: 7y1 h S'S (0
Phone No 7 Z sY %S'�'
,d,IT411gitl,
Fill in fee simple Title Holder on next page (if different
/2
E-Mail 7 74-(/k� (u li14y;j�n ww_5 rC
State or County License e /2 .S 3/ 9
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.
DESIGNER/ENGINEER:
Name: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
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.
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
improvemeiAs to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie Cou y and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with len er or an a-Uornev before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID
COUNTY OF ,!J „f`t
Swor t (or affirmed) and subscribed before me of
hysical Presence or Online Notarization
thisV day of, f')L� 20ZIL-by
Name of person making statement.
/ OR Pro Personally Known 6duced Identification
Type of Identification Produced
(Signaturb of Notary Public- St a 6f Florida)
6URFOR
Commission No. (Seal)
FATHER public
,111�,,, H Fio Notary I I
PUBC�StBte of nd # CC 1832
O�PpY
fission
CMY Commiss06n 2022 es
o`c
February
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21