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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED O
pp "�' o Permit Number:CQ.1,
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Date: �9 ' o�
RECEIVED
91T. CUC1I�
AUG 0 5 2021
Building Permit Application 51, Lucia County
Parmlttln
Planning and Development Services
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: -DC C
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WN
Address: -z IN seh...
�f%�'ot � s C7e�x p ��ve �e�•t- S` oLq c -.
Property Tax ID #: SF S/� ®°Z - 6 o -® � � Lot No. 5";2 9
Site Plan Name: A® fi.v f' �elv r'0 Block No.
Project Name:
d beck 6v; �-e k
S r / Akita c'm P`% k5
2
New Electrical Meter Second Electrical Meter (Affidavit required)
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: Q p)c t Sq. Ft. of First Floor: UY A
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
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NEW _
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Name di"�� + _ - •41 LL-r
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Name:
Address: T -7 O %SvrG1. vL &(A) P •
Company:
City: r &. State: %
Address:
Zip Code: l (,z Fax:
City: State:
��PP
Phone No. (o �' �i 07- 1T8 -7
Zip Code: Fax:
E-Mail: tg'"o��er J gh&eP 41p
Phone No
Fill in fee simple Title Holder on neat page ( if different
E-Mail
from the Owner listed above)
State or County License
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.
DESIGNER ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: E
Name:
Address: _ W. . i r►v e
Address:
City: Pit St uc i ,h State: F L
City: State:
Zip: -'.,Phone -1•77— - 16i g T3.2V
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 you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of 0 er Lessee/Contractor as Ag nt for Owner
STATE OF FLORIDA `
COUNTY OF
Swor o (or affirmed) and subscribed before me of _ Physical Presence or Online Notarization
this day of 2UJ I by
Im d -.L
Name of person making statement.
Personally Known OR Produce Identification - 1
Type of Identif' ation Produced C ,
(Signature of Notary PubliiAtate of Florida)
;.iot......
c i AUDREYg,
sr MY COMMISSION GG 30 817
Commission No. (Seal) "a: ' -
-"� `' EXPIRES:
March 6, FOFF�gP; 2023
Bonded Thru Notary Public Underwriter;
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