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All APPLICABLE) INFO MUST BE COM ETED FOR APPLICATION TO BE ACCEPTELiy'
Date: / ' ' v�) Permit Number:
S5� . RECEIVED
- O L5h1 JAN 1 1020
p Building Permit Application permitting DeP�rt►er�t
Planning and Development Services St. Lucie County
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 16-3a5 AlG{ eltom Uw✓ e,
PropertyTax ID #: yiagy— 5-0/—
Site Plan Name: IIVaf
Project Name: T1Ya*y,-4,e
-adlo^
Lot No. OZ /
Block No. f3
DETAILED DESCRIPTION OF WORK: I
t.- - I Ifr - - - ..c. ; I d__. d-
New Electrical Meter SecoA&Electrical Meter
CONSTRUCTION INFORMATION:
Additional work:to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbin�gju Sprinklers _ Generator _ Rootf� Pitch
Total Sq. Ft of Construction: �O / fU Sq. Ft. of First Floor: —3
� J�mo mo
Cost of Construction: $ o� % Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 'rilo l & r, doll 'ice
Name: -t ' *eke
7� a v�'o„ &11 v-e
Address:
Company: �t �a✓r Oc 56rr�s1.
LL/�536
City: /_ L ' C State:
Address: !� I✓i �/
Zip Code: 3Y9 ;? 7 Fax:
City: Aor�
Phone No. y i - �7i'-a 73 q
Zip Code: 3 Fax:
E-Mail: DSSDA'P a t?,, 1Y ig A4,,
Phone No —5d/—i00
Fill In fee simple Title Holder on next page (if different
E-Mail /'i G .1170A 7n V wo, , i t^0 A, `
from the Owner listed above)
State or County License 3 0 7 3d
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: — Not Applicable
Name: &11L4 M# XYY!� f
Address:'/*/ viln-ploldRo6 iijAia
City: 19pleyi o6o State:
Zip: Phone %07— 7d /-aa �.
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: —Not Applicable
Name: I Name:
Address:
City:
Zip: Phone:
Address:
City:
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 attornev before commencine work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
CO NTY OF i WV S
STATE OF FLORID
COUNTY OF ,\X
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Sw rn to (or affirmed) and subs i o
rn to (or affirmed) and subscrib
0,4;IotarizatbQIAPEREIRA
by ical Prese ce or O li•'' ^ rizatiorOYANAPEREIRA
this=� • kbik— public - State of Flo
da Of ofary Public • State of F
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Commisslon # HH 056400
Commission a HH 056
Comm, Expires Oct 22
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Comm. Expires Oct 22, 2
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Name atem
me of person makin tatement.
Personally Known OR Prod_uceed Identification_
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Personally Known OR Produced Identification
Type o Identi Ic ion Ljp A L9
Produc d _ J
Type f Identificati �P�►'i►'�! S
Prod
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N hA�A�Vr,
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(Signature o of - tate of Florida)
Signatur of Notary P!!',AbIic- State of Florida )
Commission No. 03 (Seal)
Commission No.44146S(C'403 (Seal)
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