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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED — ('�
Date: Permit Number: i9?'o.�,0) `'S 7
RECEIVED
�: �,- ��..MARQ_.,,VA,` -?>�4., Building Permit Application St. Lucie County
Planning and Development Services Pe'm+ttln�J
Building and Code Regulation Division COmlmercial Residential r//
2300 Virginia Avenue, Fort Pierce FL 34982 I
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: I
f..' > y S s. x� Y:
YPROPOSEI�l I ;P �OVEI1 EI T L 3aCA1( t�1r� j. �o s ,his A 51- ,
Address: 670/
Property Tax ID #: 6, e l Lot No36 Y-3 (-
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Site Plan Name: Block No.
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Project Name: I
New Electrical Meter
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Electrical Meter
(Affidavit required)
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank t _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator V Roof Pitch
Total Sq. Ft of Construction: �,�a- I Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
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O1NnER%,ESSE:�{QNl'RACTOR
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Name4E,01Fze7—,DW~ese7—
Name:
Address: SZG l
Company:
City: �CJ _ PCgF_-,e<eF State:
Address:
Zip Code: 3 V2?� Fax:
City: State: r-L
Phone No. 7 72- ;-_Z4?40 O0/ 5- E-
Zip Code: Fax:
Mail: 0 '�Q z A<-Aece 04_
Phone No j29-
Fill in fee simple Title Holder on next0age (if different
E-Mail Atoq-zz, ad ar
from the Owner listed above)
State or County Lich �--
If value of construction is 2500 or more, a. RECORDED Notice of commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
_,'Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: �1Dtt Dig
-Name:
Address: G d, ZZe&I
r
Address:
City: A -
I State:
City: State:
Zip-. L G 9 Phone3
7�s2�f®3
Zip: Phone:
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FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
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Address:
City:
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City:
Zip: Phone:
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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 l the issuance of a permit.
St. Lucie County makes no representation that is rantin a permit will authorize the permit holder to build the subject structure
which conflicts with any. applicable Home 'wnersAssociaion rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t with your Homeowners Associatio i 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, thFlorida Building Codes and St. Lucie County Amendments.
The following building permit applications{`are exempt from lundergoing 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 failur6.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 lander or an attornev before commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of . 20_ by
Name of person making statement.
I
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Commission No. (Seal);
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21