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All APPLICABLE INFO,MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:^3• /?• Permit Number: 1703"o g /
RECEIVED
Building Permit Application
MAR / 8 2017
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)4624553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PR®!P®SED INPR,01/E;MENT LOCAT ON:
Address: J—"K QLlo
Legal Description:
Property Tax ID#: T 1 V 0 �" D Lot No.
Site Plan Name: Block No.
Project Name: h
Setbacks Front Back:' Right Side: Left Side:
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ETAIIED D SSC I'PTI®N OF O'RtiK:
C C-it,q-Q91,, V-S
J�U@N=TIMNINWRMATION:
Additional Work to.be pertormed under this permit-check all.that appy:
_Mechanical Gas Tank _Gas'Piping 'Shutters' _`Windows/Doors i,.
Electric Plumbing _Sprinklers _Generator Roof Pitch
Total'Sq.'Ft of Construction: Sq. Ft.:of-..of
Cost of Construction:$ r b ` Utilities: _Sewer _Septic Building Height:
OWNER/LE�StiSEE: CONTR CT az R:
Name vcr, i Q Name: k-kkA, .
Address: a-'0 w. i�e� Company: `�� �� �,L
City: `^� State:�� Address: - 5 C
T,
Zip Code: � Fax: City:
Stater
Phone No. Zip Code: 3 `(C( �— Fax:
E-Mail: Phone No 7 ) 2=3 2 V e
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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S�U'PPLEM�E�NTA� C«O'NSTR.UCI"I:ON LLEN LUV IN�OR`M�TIOh�: µ
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'. ii-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 ori the jobsite
before the first inspection. If you intend to obtain finandri&'consult.with lender oe.an attorriey•before
comr
,P"cing work or recording our Notice of Commencement.
FF
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N-
Si ure of Owner/Lesse actor Agent fI� Sig ture of Contractor se Holder
s C &5 0=5 a
STATE OF FL STATE OF.FLORID W MFw Z
COUNTY OF ga COUNTY OF ¢0�t
¢�U
The forgoing instrument was acknowledged befor c The
ying instrum t was acknQQ��wledged b ore m�this day of 20�by m thisday of CXR �1`'20m;�I��'�:y"rry�oq)"
v n
(Name of person acknowledging) (Name of person acknowledging)
el -d
(Signature of No ry Public-State 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 Produced
Commission No. (Seal) Commission No. (seal) ,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. /2014