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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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
PERMIT APPLICATION FOR:
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P 0'PQ ED IN�RROUE�MfNT L*CATI�QN:
Address: 661 o PA AAAI C✓ -�old Rc Pa(-Ce- `IA- '34(i51
Legal Description: F`� �(�
Property Tax ID#: 1301 .{o ly- M d. (000') Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Sidel:
�' A;SLED DE=�SG I'PT OWN OF 1NOR'IC•
�ONS� RUCTION )NFORM TION•
Additional work to be pe Orme under t E permit-check all tat appy:
_Mechanical Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric " Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor*
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Cost of Construction: $ 5on•bo Utilities: Sewer —Septic Building Height:
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D70.N /LESS'E C CTO:R.
Namg7 . P.110 Name;
Address:-76'1 'Sn er��/ Company:}-1�l'Q .. dv-:'�'\.��rrn�Ji� �.LC
City:,l- �- State�L Address:!T576l 1. ?a,60AA':
Zip Code:3`���� Fax: City�t-n��- ���e���' State: C�
Phone No. -T70- 36t— ,3.P,9-1 Zip Code: Y�t S-I - Fax:
E-Mail: Phone No rd
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Fill in fee simple Title Holder on next page (if different E-Mail�K^. -{� '�-r \q 102- L�-CU
from the Owner listed above) State or County License C fi C: /W-7
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
5 PFLEMENTAL CONSTR'C1C:T1N LIEN LAIN INFO MAl'ION:
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 your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
e Rcing,work or c rding vour Notice of Commencement.
V
ature of Owne Lesse(V tractor as Agent for Owner Si ature of Contr tor`/L'ic se Holder
TE OF FLORIDA STATE OF FLORIDAUNTY OF TN*Mi . COUNTY OF T'n5NL-,n ,�Y.Y Ceynk
Theforgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this y day of Yy),Dj1c h 20a by this day of (VI(-KY (,�-, ,20jI by
(Name person ackno edg ng) (Name of person acknowledge )
(Si ure of Notary Public- to of Florida ) (Signature of Not Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification .
Type of Identification Type of Identification %
Produced 6ASHAHNAINGRAM Produced D)rW9 )r `1L
� GATSIN FEDE
d"yP(,4
c=0 ;�•: Notary Public-State of Florida oQ ��NOTARY PUBLIC
Commission No. a • ° .=My comm(= )res Dec 20,2018 Commission No j 2 01 1} OF FLORIDA
o` . commission#;FF 177249 " 2 Comm#GG066420
•'•.,'�oFF�p�� Notional Notary Assn. s�N g1�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014