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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6- `)- l7 Permit Number:
RECER`-D JUN 09-2017
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: f .
PROPU�SED INPR®VEMENT LOCATION:
Address: ZO Ve Pcc.j.'-�-z2r 94 &e- re e j% 3y9yS- ggqQ
Legal Description: 17, 25 39 Z-7 //b l'7 0r S ll.S F7 o E F7 OF C
OFA1 15� 6-F Alt"I (DF W Li CQJA Ac) LO{C a0- 5.25
Property Tax ID#: ,: 5 17 -,;�a l- 00/S- Ol'Ol g Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D-ETAILED QE�SCRhPTIO'N OF OR�K:
0 r qq ct r o er he r 'ne
CONS1'RUCTIO INFO` I�/IAl"IO.N:
Additional work to be pe Orme -under this permit-check all that appy:
—Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
V Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor: Y
Cost of Construction:$ 000 Utilities: —Sewer _Septic Building Height:
OWNER/LOOM-EE: CONT ACTOR:
Name _W c aide-_ :F Ffe Name:
Address: IOLfW Pwl ,--zer Company:
City: F-4. /;`e.rc.+e State: Fl, Address---r-'
Zip Code: ,3'el91 Fax: City: State:
Phone No. 77:)-- of ,1 - 92V? Zip Code: Fax:
E-Mail: /2bo e. Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement-is required.
StJ PLETMENTAL CONSTRUCTt®N Mt NiF RIUTATIO.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 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
comm ncing work pr recording our Notice of Commencement.
S' ature of wner/Less /Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOR��A STATE OF FLORIDA
COUNTY OF ��+'. ��'� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this°\ day of v`K ,20 N1 by this day of 20_ by
W0, 4\ \ ' le,
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publ -State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced :: NNA MARIE GIVENS Produced
41y poMFAISSION#GG 022623
Commission No. ' fix IRES:De0pW 6,2020 Commission No. (Seal)
'`�'f K? ' Bonded 7hru Notary Publionderw6ters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 112014