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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:M>�'%c-f'1 a,=,) " a y 1- Permit Number:
RECEIVED
r MAR 2 2 2022
Buflding Permit Application St.,LucieCounty
Permitting
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR m
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Site Plan Name: Block No.
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New Electrical Meter Second Electrical Meter (Affidavit required)
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Additional work to be performed under this permit- check all that apply: - e
_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:
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Cost of Construction: $ �V�Q' �%• Utilities: _ Sewer _ Septic :Building Height:
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Name y- Name:
Company:
City: -� -%�P State: Address:
Zip Code��� 2 Fax: —�- City: State:
Phone No. Z�2 m l--al --2:, E- Zip Code: Fax:
Mail: e-1 Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
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, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: :.Plione
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City: _
Zip:
Phone:
Not Applicable
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.p'rior 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 consu t 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 pub'lic'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 Vour Ndtice`of Commencement.
W—Y-Y-
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Signature of Contractor - or - Owner ilder a pplicable
STATE OF FLORIIIA
COUNTY OF
SworAto or affirmed) and subscri ed b fore ine of
this' ay of � %7 �G, 2
Physical Presence or Online Notarization
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Name of person making statement.
Personally Known ro uced I tificati n
Type of id e tification Produce '
(Signature of Notary Pu i - Sta e of on a)
Commission No. (Seal)
;g:�?YP�,; AUDREYB.HUMPHREY
COMMISSION # GG 300$17
'V. AMY
-oz EXPIRES: March 6, 2023
'•%FOF cy°�' Bonded Thru Nolm Public Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
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DATE
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DATE
COMPLETED
Rev 10/12/21