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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE. ACCEPTED
Date: L 0;! �• �% Permit Number: /
5EOEIVED
Building Permit Application JAN 2 7 2021
LucPlanning and Development Services 5t. perm County
Permitting
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:
Address: -� �� � � 0`°'�%� 1 6;rr I f 1 e` FCr_ 4 J1-
1 0.' 1 V lJ /• Lot No. 7
?roperty Tax ID #:
Site Plan Name: i,-r 'P(� 'L� C� r D c----7VS Block No. 6
Project Name:
ON I
T_I N T L
� � y �� � j � � � ram►-�-- � � o � � � � �� � � p � �`l� �
New Electrical Meter Second Electrical Meter (Affidavit required)
Sd L sue,
Additional work to be performed under this permit -check all that apply:.
Gas Tank Gas Piping _ Shutters _ Windows/Doors _ Pond
_Mechanical _ _
_Electric Plumbing _Sprinklers — GeneratorRoof ld�- Pitch
Total Sq. Ft of Construction: �� 75 Sq. Ft. of First Floor:
Cost of Construction: $ �/� , U C"'O r — Utilities: —Sewer _Septic Building Height:
NameM%CAAcZ f !tSC)SOP4*itj(�_ {' f'
Name: %r
i
Address: asso
City: _ Pl r=72cz State:l-L,A,.
Zip Code:;Wq+- Fax:
City: State:
Phone No. - 77 2 — —40+' e�
Zip Code: Fax:
E-Mail: r' M t k(2 1CO � f�C0L. e C.,0M
Phone No
Fill in fee simple Title Holder on next page { if different
E-Mail
from the Owner listed above)
State or County License
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: --Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: ' ' "`
Name:
Address:
Address:
City: State:
Zip: Phone
City: "State:
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 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 reviewyyour 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. publ'ic'records.of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with I er or an attorneybefore commencingwork or recordin ' our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for 06her
STATE -OF FLORIDA
.COUNTY OF o5,T bias—
/'
Sworn t (or affirmed) and ubscribed before of V Physical Presence or Online. Notarization
this day of �A 202 by,
(nL���o��e���
Name of person making statement.
Personally Known V OR. Prod uce'd.1dentification
Type of Identification Produced
ig ure of NotaryP.ublic- State of Florida WCILLE D. PERDEW
,,••
MY COMMIS SION#HH088581
&., 4 r �F
Commission No. 11 IJ (Se"mx' EXPIRES: March 22, 2025'
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•. o►��,.� Bonded fiN NotaryPubft UnderxMtere
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