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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C� r
Date:Permit Number:
04 d�1C�DC
° Building Permit Application Recel
Planning and Development Services Nov 1 6
Building and Code Regulation Division Commercial Residential �o
2300 Virginia Avenue, Fort Pierce FL 34982 Permitting D@p6ft,,,,,
Phone: (772) 462-1553 Fax: (772) 462-1578 St, Curie County
PERMIT APPLICATION FOR: �'� 1 �- V, rc\�
i 1/J•
Address:
Property Tax ID it: 351151Q1' 40dO-L_ dCS(z aid -
Site Plan Name:
Project Name:
\ '�- t \ a�
New Electrical Meter
Second Electrical Meter
Lot No. —
Block No.
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: a5� Sg b
Generator Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ �� �0� Utilities: —Sewer _ Septic Building Height:
v
+•''a,} - "'inui $ %t%>m ��•' Y i. a y "�
fink's'-514it4h�"�b'W°x�x32'.P."`�t�r,.`i�PE�•4Fi,�:1F�+Y`*i�i�'.'@�7���+�r��f����,�"
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Name
Name:
1
:Company:'
City: Sri aY� �' I -weg o State:
Zip Code: Fax:
Phone No.7�
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail: ' 14-'.LL'
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
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.
FJ
l'1 a.ti p E- C ASS RU
DESIGNER/ENGINEER: — Not Apple MORTGAGE COMPANY: Not Applicable
licab
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict orpprohibit 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 roperty: A Notice of Commencement must be recorded in the public records of St.
Lucie County and pose
oon the jobsite before the first inspection. If you intend to obtain financing, consult
with/Ander � an,a'tt ney before commencing work or recording your Notice of Commencement.
gnature of Owner Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -4,\i • \—\) COUNTY OF
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Physical Pres@nce or Online Notarization Physical Presence or Online Notarization
this �� day of N dy 2020 by this day of 2020 by
Name of person m king statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifcati n Type of Identification
Produced' �— Produced
(Signature of Not State �EftiRdAWIE GIVENS (Signature of Notary Public- State of Florida )
5=my commissiON # GG 022023
Commission No. IRES:(Sei4er16,2020 Commission No. (Seal)
'��4.PF nded 7hru Notary Public Undarwrlter: 11
FRONT ANGROVE
COUNTER I.REVIEWOI S REVIEWOR PLANS I EEW I VREVEWON I S REVEWLE MREVIEWS I CO REVIEW. —
DATE
RECEIVED
DATE
COMPLETED