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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n )
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Date: �'� '►' �Permit Number:
O4 [LUCKE RECEIVED
FEB 14 2022
°�����°�`a��°"�•°Y`pf Building Permit Application
Planning and Development Services St.,Pucle nty
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Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address:
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Site Plan Name: Laa%u_ . n&
Project Name:
Lot No.
Block No.
New Electrical Meter Second Electrical Meter
b,4. �'
CONSTRU;CTIOIV'IIVFQRMATI:ON
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shatters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: ( k.G. s Sq. Ft. of First Floor:
Cost of Construction: $ "{ 7V U Utilities: —Sewer Septic
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Building Height: io U
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:CONTRACTOR J,
Name
Name:
Company: _ry
Address:
City: R 911 y e_,44 State. L
Zip Code: `40 Fax:
Phone No. (40 2 ' ZL44-
Address: OLY Ir
�i"
City:
Zip Code: �fJ V Fax:
Phone No D-1' a - zq
State:
E-Mail: 01ri
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail MAY
CL -CO
State or County Lice se literE
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.
;SUPPI.EMENTALCONSTRUCTiON LIEN LAW INFORMATION
;
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
of Applicable
Name: 1('il W
l � _
Name:
Address: L
yn w-
Address:
City
State:
City:
State:
Zip: Q00J() 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 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,yyou intend to obtain financing, consult
with lender or an attornev before commencine work or recordint; vdllr Notice of Commencement.
Sig _re of a Lessee/Contractor`as Ageent for Owner
Signature of Co tr for Licenrso lder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF 1/rliVL.Q-.i�_
Sworn to (or affirmed) and subscribed bef a me of
Sworn to (or affirmed) and subscribed before me of
_ Physical Presence or X Online Notarization
_ Ph sical Presence or Online Notarization
by
this 1' day of i- 0@28 by
this da of
soli.
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Name of person making statement. I
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Pr uced
(Signature of Not ublic- Sta ® d OTARY PUBLIC
o�
(Signature of Notary P h Sta Io ' y erg
( g ry�5 i' PUBLIC
so
Q
Commission No. TE OF FLORIDA
r CCTmm#GG973629
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�o o O RY
Commission No. � �, p OF FLORIDA
Co mm# GG973629
si Pxoires 3/26/2024
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Rev. 5/6/20