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All APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 'l !�ll
Date: .2- cl ` �-�- Permit Number: Pgvul • VP4
0 RECEIVED
° ° ° Building Permit Application
FEB 1®ZUZZ
Planning and Development Services
PFYtltting��ment
Building and Code Regulation Division Commercial Residentiffl14t. hir,m cnuntY
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
C7a�a�e Ip�io r
PROP08E6IMPROVEMENT LOCATION:,
Address: 1106 &Ille-J
Property Tax ID #: 3 %fD - (oOl - 0033 - 010 - 6 Lot.No. /2-
Site Plan Name: Block No. 2--
Project Name:
DETAILED DESCRIPTION OF WORK`:
Red loe,v, I Xl &anrt e bawnc coat-ck
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
(Affidavit required)
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE;
CONTRACTOR:
Name A.6 1 ,� &c b6r.i Sara So
Address: '766 - 6 (-i ve.
City: Ff n,'el'Ge- State: Jg-
Zip Code: 3ygf2 Fax:
Phone No. Q0- 687- l%C!'] E-
Name: �SS�c 13c�C-i�
Company: ftc GCc���t� r
Address: tJ V-Ajla3 a! 44"� X10c)
City: PGL State: JEL
Zip Code: Fax:
Phone No 7 72!ZSs -S"VU
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail A &or `
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.
'A.
SUPPLEMENTAL CONSTRUCTION LIEN LAWINFORMATION:
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 attorney before commencing work or recording our Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF -54' /LyQ -G
Sworn to (or affirmed and subscribed before me of
<sical Presence or Online Notarization
this /a day of 20Z2by
Name of person making statement.
Personally Known OR Produ d Identification
Type of Identification Produced d ./
4 Aomw_
(Signature of Notary Public- State of Flor' a)
Commission No. Seal
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Rev 10/12/21