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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
S {{�I1'I��'=�yyy�ryryry J1�F�/ P .� 2022
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p G Building Permit Application
Planning and Development Services
Building-and Code Regulation Division Commercial Residential C6 cb
.2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553-Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IM'PROVEMEIVT LOCATION.: ,
Address: l D 7,1N - =I
Property Tax ID#: '-I rc 1171� C ` t Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK;
New Electrical Meter Second Electrical Meter (Affidavit required)
[-'.6ONS'TR6,CT
1ON JN;FORMATION
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: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
ly
OWNER%LESSEE CONTRACTOR; .
Name Name: S ., - r ear,
��
'Address: Company..,,- i°
City:s�� �1t�1� 0-1-7 State:_ Address: _
Zip Code: Fax:
- 7� City: r ', C '',�� State:
EL
Phone No. gJ� 7" / / 70 E- Zip Code: ,� �J� Fax:
Mail:. Phone No ro, - ;
Fill in fee simple Title Holder on next page (if different E-Mail`Vif V Lab E2�
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,1 RECORDED Notice of Commencement is required..
SUPPLEMENTAL'CONSTRUCT{'ON.LE'EN LAW IN'FOR(VIATION ;
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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..lf you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/`Less /Contractor as Agent for Owner
STATE OF FLORIDA �L �{{ ��
COUNTY OF /y �✓
Swor (or affirm ) d u scribed before me of <Phyical'Presence or Online Notarization
this day of . 20:?Z by
Name of person making sta en .
Pers ally K own. 0 .ro ced Identification
Ty of Ide tiff ati ced
Q '
(Sign ure of -
iipY+'u", JOHN M FERRICK
Copmissio !` '. `�`: Notary Pub(ge54te of Florida
Commission#HH 127892
oFr.° My Comm.Expires Aug 26,2025
Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE'
COMPLETED
Rev 5120121