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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,> 7110 Z,2 Permit Number:
RECEIVED
I . d�1�D5 MAR 17 2022
Building Permit Application St. Lucie County
Planning and Development Services Permitting
Building and Code Regulation Division Commercial Residential 10
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: ,?y10 Wwwd Dr • hwt rw(Z
Property Tax ID #: l Y(DO
Site Plan Name: 614AIkk � St&vS
Project Name: '3/
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 _Generator _ Roof Pitch
Total Sq. Ft of Construction: /0-0 Sq. Ft. of First Floor: [�
Cost of Construction: $ (;—EGD Utilities: IoSewer _ Septic Building Height: i5 rl
ER ,LESSEE:f`,•?�t sF rx3:t,,k >a r„,tf.,�J�v, .,,C®N7R�ACTO.R:,���
sit
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Name
Name: OIV�
Company: S LAD 'J
Address: Q�10 lAAn I( I V1 1
City: RO- State:
Zip Code: Fax :1 r l —
Phone No. 6l • a. 8 3 '7 • �[
Address:
City: 1/`P�1� State: CD
Zip Code: �U o� 1� Fax:
Phone No 07 01 2� a �4
E-Mail: Q
Fill in fee simple Title older on next page ( if different
from the Owner listed above)
E-Mail
State or County Li ense(
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:COfiMTRUCTION LIEN LAW INFORMATIONr
^'
5
DESIGNER/ENGINEER:
Name: \
Addre 7
Not Applicable
5
MORTGAGE COMPANY:
Name:
t Applicable
Address:
City: 1
Zip: S12sVO Phone qO
State:
-5-g
City:
Zip: Phone:
--- _
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
of Applicable
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 inspectio . If you intend to obtain financing, consult
with Roder or an attornew before commencing work or recQrdinJ your Notice of Commencement.
Signature of 0 ner Ce see%{;
rJnt for Ow'r1er;
signatuk bfrcorractor License Holder
STATE OF FLORIDA
STATE OF FLORIDA M4
COUNTY OF
COUNTY OF 1
Sworn to (or affirmed) and su cribed before me of
Sworn to (or affirmed) and subscribed befo a me of
�Prhnysical Pres n or
this U day of
Online Notarization
,202�by
Physical Presence or Online Notarization
this day of 202aby
I, L�IAM
I /Y
�
— -�-Oq ' �&IvkbA ,
Name of person making statement. —
Name of person making statement.
Personally Known OR Produced Identification _P_
Personally Known OR Prod denti ation
Ty a of Identification
�M��
Type of Identification
Pr uce
�v
\-1,1v Pts-mig
Prod c d
(Signature of Notary Pu 'c tat N TARY PUBLIC
(Signature of Notary Publi to of Florid*"y NOTAT
TE OF FLORI
A STATE
Commission No.
-9
Commission No. (CommA
Expires 3/26/202
Expire
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DATE
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