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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 513-0—17 Permit Number: no -�lD 1
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: To Select from dropbox, click arrow at the end of line
fl Will
Address: 1 S• 6Ccx-, /IU'5 L r I
Legal Description: 1ts)n A M(CC_ \ALLA5-� A-/ T ,i- 5FA (c,.&,m In iu,,- #* 1' inn 17' ! J AnC-
P� ?Alva SN411- 1.1 Co14-1,1 �Z�� qS cote 11 1,F-!Y0 l20/-6,407�—
PropertyTax ID#: `1571 IR-10 Q /Yt9 000 -7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be Dertormed under tis permit-c ec all tl2at appy:
HVAC Gas Tank FGas Piping 17]_Shutters Q Windows/Doors
IkElectric 0 Plumbing Sprinklers Generator E]Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
aJ
Cost of Construction:$ c3 DO Utilities: _Sewer Septic Building Height:
Name '2, Z�'I i°SO Name: KiidfuH 6:1 :XF-WA /T,
Address: /08.5"/ S ®� De- 9/c// Company: �ICo e5IIL 'T,
City:_M�2537 AWH State: Address: �' /.✓�_ .t/T,r=i�P,�Z 1��-
Zip Code:3Y9.� Fax: City: Z S7 4.4 11;F,4F State:ilzL
Phone No.:Z22--7c08•-63ba Zip Code: Fax: 72z-- Y0-7r/7
E-M ail:�iA�.�.TAMr"5O e t_.rte Phone No. 777 -7—o/ z'/91V
Fill in fee simple Title Holder on next page(if different E-Mail: • / CO
from the owner listed above) State or County License��-C z��8" FC15003;/
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
MOM
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:
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 wock or recordirIg Vour Notice of Commencement.
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_Signature of Owner/Lessee/Agent Signature-of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA /A
COUNTYOF LQQ COUNTY OF
The for ng InstruMeq was acknowledged before me The forg 'ng instrument was acknowledged before me
this ay of 20 Eby thlsay of 20 by
LGuAA ejwaa_
• F
(Name of person agnowledging) (Name of person ack ledging)
L-
ature of Notary Public-State of Florida) ure of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifica Type of Identificati n Produced
OKI L WARNER
MY COMMIS :r? '% TORJl RNER
Commission No. RM PF909394 Commission No. Y COMMISSION#FF909394
'•,'�Qa� o•.•' EXPIRES October 11,2019 's?;
aor s9s o+s3 •%so'v EXPIRES October 11 2
1 07)39" 63 Florldallote setvke,wM
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS