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All APPLICABLE,INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Mgpi Permit Number:— XLVQ -nogg
91K WC E
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:
ROPQ$EUIMPR WM4-Q IN, P O1N ATIi�
Address: IV_1
Property Tax ID
Site Plan Name:
Project Name: —
DETAILED DE
New Electrical Meter
M 1112011; � &IIIIIIII — 0
a B. "A WAY, 6W ff M] I
Lot No.
Block No.
PTfQN,-OFV0RK'
N& ZDAM11" ffa-m—s CM, APPW 5" A 305A W' &NTOAL
4Y_(5F10PA-T_ NaW W AMP A 1-D.AH? t*PJ VI%qJP&:--r To A
S AN 5AHE PWIMY ("remir-4p 207-cwfl
Second Electrical Meter Affidavit required)
ON: INFQRMATIQ,N CONSTRUCTION
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: J F J V Sq. Ft. of First Floor:
Cost of Construction: $ ZCCD oUtilities: —Sewer _ Septic Building Height:
OWNERAE5�EL':'.
T
CONTRACQR"
N ZAMERY. Nn"M Name
Name:
Address: WOM ftL- K.P.,
Company: &5aw- LLL
City: R-' rg'm — State:
Address: LOWEL4W 5"
City: State:
Zip Code: 5T114) Fax:
Phone No. E-
7
Zip Code: f"Sl' Fax.,
Mail:
—
Phone No � =R
Fill in fee simple Title Holder on next page (if different
E-Mail 5*6ft M5 (0-YAtf4i%6cK
from the Owner listed above)
State or County License X * 175
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'IN,F0RMATl0N
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
Name:
Address:
City:
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 sxructures, 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 commencing work or recording vour Notice of Commencement.
16111,
SignatureJntr ctor - or - Owner Builder as applicable
STATE OF FLORIpa
COUNTY OF �
Sworq fo (or affirm d) d subscribed before me of Physical Presence or Online Notarization
this ' r day of 2t 41by
Name of perso r
a\ at ent.
y
Person ly nownOR Produced Identification
Typ2mUdelitification Produced
ignatur of ary Public- State ' LpgHp�HNAMR
w
MY
Commission No. (
VIRES: UU vniters
Q;= E
,)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21