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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a Permit Number:
°Fx F
R E C E P"7 D FEB 112017
-- - Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential Y
PERMIT APPLICATION FOR: P-Eve S�.\
PROPOSED 1N=PR•OUEMENT LOCATION:
Address: LlI LzV OtO,4 )'t3 i 405� ' PWR&6
Legal Description: IQ4 a1N19� _P4V4g_ i?� D� ��l i ALA) 157 �l23'
Property Tax ID#: :Lf5Y .701 6014, ffiPoo Lot No.
Site Plan Name: Ee%-oa&z'� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED@SORIPTION ®F W�®R
-gin oy ovc% A,uD PCsr�' gt. 36-LWS a�L �' Z 12, PtTC,;t-
CON}STRUCTIO'N INFORM'ATIO'N:
Additional work to be pertorm.ed under this permit–check all that appy:
_Mechanical =Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers _Generator _XRoof Pitch
Total Sq. Ft of Construction: 1-7D29 Sq. Ft.of First Floor:
Cost of Construction: $ t!�D- Utilities: Sewer —Septic Building Height:
191A%INS IETRE/111CINNNTRACTOR:
Name i ftEZ�t,<rav�-S irbr•► �rr�t�c�' i.LC, Name: Srer�J . TBrti�Cr,�
Address: 77:6-8'_S &C 14uiCompany
City: PSL State-11, Address:-3Z�10 LE)w
fbt�
Zip Code:3 �i�S Fax: City: f"i PCc!d State:rL
Phone No. Zip Code: 3a5M Fax:
E-Mail: Phone No 7)Z–-0i4--9&q�
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License S' L14aa
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CON-STRUCTI®IV LIEN LAW LNFORMATI®N,:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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 your paying twice for
improvements to property. A Notice of Commencement must be recorded and on the jobsite
before the first ' spe t' If you intend to obtain financing, consult with le r an atto: ney before
commencin ork rec rdin our Notice of Commencement.
ignature of Owner/Lessee ontractor as Agent for Owner Signature of Contrac or (cense Hol
STATE OF FLO IDA - STATE OF FLORIDA G,
COUNTY C. -C . L, U c COUNTY OF Sic .
The for oing instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this\day of 20LT by this A day of ,20]4 by
2AIz-J �_' h C �'S -� e-,11 C
(Name of person acknowledging (Name of person acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of Notary Pub' -State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification 'smType of Identification
Produced SMNAMARIEGNENS Produced_{ GNENS
MY COMMISSION#GG 022023 •,..,f.v' DERNNAi21E
pecember 16.2020 ; � C MMISSIQN#GG 022023
Commission No. '� ? E pubticundenvnlers Commission N ES:pecemb i 0
G„�oA Bonded Thtu Notary :? ....�oeA= Bonded Thru Notary Public Underwrites
•;F ••
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014