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Ali APPLICABBLE.INFO'MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l Permit Number:'tid �3
RECEIVED
01r.
L�l�l�0 LS
p JAN 0 7,1010
°µ Building Permit Application
Permitting Department
St. Lucie County
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, -Fort Pierce FL 3-4982
Phone: (772) 462-1553 Fax: (772),462-1578
PERMIT APPLICATION FOR: S
Address: I /-) 14 e/) 4.11 v
Property Tax ID #: A/ /8 - 6V -- 003y -0019 Lot No.
Site Plan Name:
Project Name: 5I&MI ✓ZESlde" f
New Electrical Meter 1/ Second Electrical Meter
Block No.
Additional work to. be performed under this permit —check all that apply:
✓Mechanical _Gas Tank _Gas Piping j[_ Shutters
✓Windows/Doors Pond
_-VElectric ilPlumbing ._ ✓prinklers — S Generator , V' Roof g�� Pitch -
Total Sq. Ft of Construction: 3t5 9e�' Sq. Ft. of First Floor:
Cost of Construction: $ 2 o Q nao Utilities: —Sewer ✓ Septic Building Height: / Z�
Name I f W of 19/7 In IzAr
Address: 7,zl4,9, Sc✓ �h `"/va S7—
City: /2 S L State:
Zip Code: 34f91�3 Fax:
Phone No. f4% - 0 �,3�rs ��'6/ 6�2
E-Mail: !d l34Ir°t0%40 &2Z22
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
_2 P_.Y..............,^..+ iC ron nirad
if value of construction is z5ou or more, a Kruurwru NOZME v�
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
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 is in conflict with any applicable Home Owners Association rules, Lylaws•or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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
:+4i ..,a .. ,. ,� ,++r„ knfnro rn�, monrInQ %A/mark nr rPrnrdina vour Notice of Commencement.
VV l l.11 1G"U4 — yva.. v. �. ............. ...... .. _.
.. _.-----._--
Signature of O ner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5 V LvcFI\'411-
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this ''1 day of Z 202# by
this day of , 2020 by
'ra � •��irc.-,n S :N�
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature o Notary Put' - State of Florida)
(Signature of Notary Public- State of Florida )
" ELLEN VAII )
Co GHN a
Sear
Commission No. (Seal')
State of Florida -Notary Public
r- Commission # GG 2700
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Rev. 5/ 6j2U