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All APPLICABLE IN O U T E COMPLETED FOR APPLICATION TO BE ACCEPTED ;P 4
Date:. Permit Number: '"
_ 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
I
PERMIT APPLICATION FOR:
RROPOSED I'N�RRO�IEM'ENT L�CATI®►N: ?
Address: �9 ani �Q�cl,ytcy �i.�S_ v �� e (`C 7 !J /?y
Legal Description: ,� �c�c i 1,�-S 14 • 1..X
Property Tax ID#: .1 (-yS-p S47--oar 3 Ia Lot No.
I
Site Plan Name: Block No.
Project Name:Zo(n
Setbacks Front Back: Right Side: Left Side:
DETA LED DE�SCRIPT'1ON OF WORK:
T
I- tl
C®NSTR?UCTIONS ENFO'R+MATIN:
Additionalworkto . e performed under this permit-check all that appy: +
_Mechanical _Gas Tank _Gas Piping _Shutters I' , —Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OWNER/LE-�S ff NMTRA 0113,
Name Name:Name: �a1�tti '��.�.�-��—'
Address: 2ac3 S' �Q�c�.v�c�� a Company:
City: ^ �c41r State:F/ Address: 7 0 i '!`c SPC,t-
)3�
Zip Code:3y ?s Fax: City: -7./—, pw_�' State:-2/
Phone No. -77-Z -C1 Zip Code-;34'R--5'_ f I Fax:-77z-009 oar
E-Mail: Phone No 772-- o 2
i,
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County Licen e_CC.c 13 0 Vo 4,
Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
�UPPLEIUIENI'Al 'C®NSTFtCJ`CTI;®N LI'E'N LAW IN+FORMA►TIIBM=
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,
commencing work or recording our Notice of Commencement.
agure of Owner/Lessee/Contractor as Agent for Owner ure o ontrac r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF S±1U( ,�'��
The forgoing instrur�ie�t was acknowledged before me The forgoing instru ent was acknowledged before me
thiS�day of I"� 20 -by this day of 20 1�y
(Name of person acknowledging) (Name of person acknowledging)
CAM(Signa f Notaryblic-State of Florida) (Signature of Nota Public-State of Florid )
-Personally Kno 0 ro cea ldbntificatio�.- ersonally Kngw � OR Protlucechdentification
} o,- �IGELA M HUFF ' - (' �,
ANGELA" .
Ty e _ #�: Notary Public-State of Florida f+j Produced ;a� °P Notary public state oFfi
Produced c�� p .
FF2 4730 ,? «��;.` w1yGo F23 Florida
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` ;oF�,o�•° MY Comm.Expires AAa mm 4Z
�j „ „• 7 2r) %J' � �Ronde EaPires N( 5 0
Commission No- ,_. ._ hflad�dtrroo�!;,,.! ;;(Sel " Commission No. dthmugh
rV'atio ;g r.
National Notarygss 'J
REVIEW_ S FRONT ZONING :, -SUPERVISOR PLANS VEGETATION SEATURTLE.. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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