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D FOR APPLICATION TO BE ACCEPTED
Permit Number:
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All APPLICABLE INFO MUST BE COMP,
Date: 5 —2OZ )
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Building Permit Application
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 CBDG Funding
PERMIT APPLICATION FOR: Masi-ep- &TN Rtn o&(_
Address:
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Property Tax ID #: ?oZ (o -- O 003 - Q Q0 zq Lot No.
Site Plan Name: �// QQ,� //�Block No.
Project Name: (/�; y4u llo #�� !� APq 1/CpnSi)�On
V,MfiC Oa&krS Flo% A I M b(nQ, 7V6 , Deaf&VAPAe
(0-fv b a,r�a- , (hove G1C��� �� l�rlrlaw neOW /QKaA,9',1 (7 j;w?4-f./
New Electrical Meter -�—Second Electrical Meter N,fA (Affidavit required)
;CONSTRjI�JCTION INFORMATION � �'; 1 f,.� m�5� ,` � °'
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters V Windows/Doors _ Pond
_ Electric %/ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: c?& & sue- Sq. Ft. of First Floor:
_ Roof Pitch
Cost of Construction: $ (o0 ,Q= �— Utilities: ✓Sewer _Septic Building Height:
h
Nampjnhri 6j&rjQ(1C)jK--rMArUjI 0 O
Name: IGRED E-M 1W #Q
Address: 14s /li(.v w&+ 604
Company: FdR Cond-fbas --�fJG
City: Ram A:hl State: R,
Address:a,;)-( SW M bn4e-2f�1 (cj
Zip Code: c3 `f 4 TO Fax:
City: t State: -
Phone No. ?P/ - -772, — 08,12 E-
Zip Code: 3 (f 9 9 O Fax:
Mail:
Phone No -Z -1 a - a-3-1 - -7 Z 9 1
Fill in fee simple Title Holder on next page (if different
E-Mail 6I ran e- (P �ci r Co n4Y &-DR 5 , CO rr�
from the Owner listed above)
State or County License C6C/aS'aY %Co
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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SUPPLEMENTAL
CONSTRUCTION L"IEN�,LAW<INFOiRMATION ; : d .�<,..�'`
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
v Not Applicable
Name: ON A Archt 4ccf 5 e U L
Name:
Address: 4/S .S. bAbcocK S-r•
Address:
City: 1?1Q_ Bovrn1G State: R,
City:
State:
Zip: 3a90 ! Phone 3a i - `7;t 1— 9D 9[o
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 grantin 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
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
\IUith Ianrlar nr nn attnrnav hafnra rnmmpnrina wnrk nr rprnrdina vnur Nntirp of Commencement.
bs for Owner
Signa ure of Owner/ Lessee/Contractor Agent
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of ✓Physical Presence or Online Notarization
this day of QL°l7i6Zie , 202J by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Sign ure of NcdAry Public- State of Florida)
Ay ��e;•:
o G SUZANNE MARIE AMORUSO
Commission No. 96 3�O III (Seal) Notary Public State of Florida
Commission Ji GG 350111
My Comm. Expires Jun 30, 2023
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