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' MUST E COMPLETED FOR APPLICATION TO BE ACCEPTED
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I Date: Permit Number:
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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. `r CBDG Funding
PERMIT APPLICATION FOR: ��`., / vG w
PROPOSED IMPROVEM LOCATION: — On— D p
Address: S d ofz� C f / td-
/ / r
Site Plan Name:
Project Name:
Lot No. l
Block No.
IDETAI ED DESCRIPTION OF WORK:
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New Electrical Meter Spcnild Electrical Meter (Aifidavit required)
CONSTRUCTION INFORMATION:
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: $ �Ck { Utilities: —Sewer —Septic Building Height:
OWN ESSEE:
CONTRACTOR:
Name `/ &4 ice/
Name: S'C
f C
Address: Sd� J e /!/
Com o_r
d
City: Obi /-'/-&State:L
Address.
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Zip Codk: Fa c:
City: PS
State: /CZ -
Phone No. -7%42- ZZ D- SQ 6 C�p E-
Zip Code: ?d
Fax: ^Ax
Mail: /V D,0-�
Phone No 7
2-0
Fill in fee simple Title Holder on next page (if different
E-Mail . O5d.)
from the Owner listed above)
State or County License
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Cam
it vague or consirucaon is csuu or more, a KtcvKULU 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 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 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 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
with lender or an attornev before commencine work or recordine vour Notice of Commencement_
Signature of n r/ Lessee/Contractor as Agent for Owner
STATE OF FLOR
COUNTY OFQ ,
Sworn to or affir d) and subscribed befo a me of Physical Presence or Online Notarization
this day of 20-1 by
Name of person m ing statement.
OR Produced Identification
Personakiwa
Type ofion Produced
Si nature &4&ary Public- Staof Flo )
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i+_' EXPIRES mber Dece20, 2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
RCv 7/LV/Li