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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
_00��3
RECEIVED
Building Permit'Application
Planning and Development Services FEB. 2 2 20ZZ
Building and Code Regulation Division Commercial Residential 11
2300 Virginia A venue, Fort Pierce FL 34982
PERMIT APPLICATION FOR:
Site Plan Name: Block No.
M.- W-t-
New Electrical Meter, Second Electrical Meter (Affidavit required)
,
NO -
01,11- W.,
-
ME 0—
Additional work to be performed under this permit— check all that apply:
—Mechanical' —GasTank Gas Piping Shutters Windows/Doors fond
Electric Plumbing Sprin'klers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ -�ruti iti Sewer S�ptic Building Height:
Name U AA
Name:
Address: 5ov-d-It-e"
Company:
Zip Code: '3 Vq %4 5 — Fax:
City: State:
-Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
It 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 ApprhORTGAGE COMPANY: Not Applicable
Name: P. -nose &4 I t- ~`,�; n� ^ r .tc,came:Addressq,3
So., �,�a� ��-.ddress:
City: Fd,+ D,'«� State: FL_ City: State:
Zip: 34ggr, Phone -7- 7, . q-74 — 0 1 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 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.
.ice
Signature o Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Ritz&,
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
th'�� day of`��,1�.- 20WL by
Name of p on making statement.
Personally Known OR Produced Identification
Type o lentification Produced
••',; y%'k--, LASHAHNAING
( ign ure o ary ublic State o rida) =� •_ MY COMMISSION#GG!S2
.Bonded7hrutotaryPubNcU
'kp'doQe EXPIRES: December20Commission
No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
., PLANS
VEGETATION
SEATURT.LE
MANGROVE
COUNTER
'REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev5/20/21