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:)ALUAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED AUG 02 2017
wilding 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
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Address-aol() "_tT_C -W(2*0
Legal Description:lmicm QJ1\ff E51= UOA bq &4_1(p WV
Property Tax lD#: )a - LIC) - 01411
Lot No.
Site Plan Name: Block No.
Project Name-.%, Imn lta)t,
Setbacks Front Back: Right Side: Left Side:
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Additional work tobe Dertormed under this permit—check all atappy:
F1HVAC 11 Gas Tank F]Gas Piping M Shutters F]Windows/Doors
11 Electric FI Plumbing FISprinklers F ]Generator F-1 Roof
Total Sq.-Ft-of Construction:- S . Ft.of First Floor:
Cost of Construction:$ Utilities:FjSewerFlSeptic Building Height:
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Name y-T e-: YAP, Name:: 4'51� Wki.
Address: ,5(, I C�' RD"k 1 Company:!_��(.-� 00,
City: State: f: C- Address: 4 U j -7q
Zip Code: Fax: city: i ah�k lrl-,- (c. Ire
State: F
P h o n e No.7-2 q& U- Zip Code3sq I a- -- Fax:
E-Mail: Phone N o. .5 h I- V.5 0
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.
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DSIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
IN,ame: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
f' FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
1 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 appiicabie home Owners Association`ruies bylaws df and covenants-that may re`strict 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 reclor4ing your Notice of Commencement.
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eUNtTY
aure cf genOwner/L e t gna ure Contractor/License Holder
E OF FLORIDA STATE OF FLORI A
OF COUNTY OF ch
The forgoing instrum*twas acknowledged before me The forgoing instrument was acknowledged before me
this 94 day of 20 -.by this day of L,4 ,20 0 by
1 est - 1 �1
(Name of per acknowledgir}g (Name of person acknowledging-)
(Signator of Not tc-St o Florida} (Signature otary ublic-S e of Florida)
Person y K/n, v
t.if_ication Personally Known OR Produced Identification
Type Idenon ProduceGt4� Type of Identification Produced
GEORGE V1NUot��v Pue� �FF-1 YOUNG
qCfgission No. FdYC^nfhnISSIOV"FF951GB9
mission No. �qI}Rotary Public,State of re r°Cornsr�ission# FF 93 V Fxai2ES:karn 2.2020
" OF FVO` MAU-Q I nN t0get Notary ZE[YtCES
Revised 07/15/2014
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