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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - G i Permit Number: se Z'—0 1-
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5V.�l�cm~ RECEIVED
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MAR 2 3 2022
Building Permit Application St.,Lucie County
Planning and Development Services Permitting
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: Fit-, Y 1 C�tSL
PROPOSED LMPROVEM`ENT
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Address:
Property Tax ID#: 290 6 —AP `00 Ob —066— 5' Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF771
// lie /'S
New Electrical Meter A,-' Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors Pond
�ric _Plumbing —Sprinklers -Generator —Roof Pitch
Total Sq. Ft of Construction: j Sq. Ft.of First Floor:
Cost of Construction:$ , uv Utilities: i Sewer Septic Building Height:
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OWNER/LESSE:E � - �CONTR;4CTOR - i
Name /���:���`��� -,c .T, Name:All
Address: �n�d l Company:
Cit 5 �—
Y� � cl<r State: Add ress:1 „?p,VtJ 0�eJe 4'wx l#a?
Zip Code: Fax: ���
City: �1�10 State:��
Phone No. 1 2 9W -?:? E- Zip Coder �fif Fax:
Mail: Phone No
Fill in fee simple Title Holder on!next page(if different E-Mail�ap0-%c�f:�eG/�era,`ce3 irc
from the Owner listed above) State or County License kC 4 cn 7072
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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMAL ION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDERS _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 Ton the jobsite before the first inspection. If you intend to obtain financing,consult
with lender or an attorney before commencing work or recoiding your Notice of Commencement.
Signat Aiio'-n'racto6-6r-Owner Builder as applicable
STATE OF FLORIDA o
COUNTY OF
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this day of 12U-! ZQy
Name of person making statement. /
Personally Known OR Pr a Identificat' n `�
Type of Identification Produced C
(Signature of Notary P c-State o Florida)
AUDREY B.HUMPHREY
Seal
Commission No. Q
(Seal) =z°;Y v °;= MY COMMISSION#GG 300817
a EXPIRES:March 6,2023
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ThN Notary Public undetwrier
'•.EOF PL,., Bonded
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev 1U/12/Z1
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