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All APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �7 �r
Date: �1 22 / Permit Number: 1
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Building Permit Application AUG 2 2 2017
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
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PERMITAPPLICATION FOR:
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PROPOS,E�® INPR®\/EMENT LC7CATi®:N= olm�r M 1 �
Address: 9 !52Y D;&14.40- Piy'G FT- ei erC.e.
Legal Description:_ L& u e -7 tom 3�
Property Tax ID#: / So 6 - 6'01 JVD- - 0,00 7 Lot No.
Site Plan Name: 1 Block No. 73
Project Name: Ro ' '<-
Setbacks Front Back: Right Side: Left Side:
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CONSTRIJCT(ONINFORMAT� � � ` ; � = ur -15
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Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ .012 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE ` x CONTRACTOR. 4
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Name o Dir -ev Name: �
Address: 6Sgy �JG �
,e j Y�V _P Company: kgc
City: E r. el-le lrc_e State:XL Address: Q.36 S klyc .
Zip Code: -3y7Si Fax: A.-A City: El-, 69) erg.-t State: PL-
Phone No. r/,?- ���6 " ��3��7 Zip Code: S19 y6 Fax: 77.1- yG/-(7
E-Mail: " Phone No. 77.2 - 370-.2741S
Fill in fee simple Title Holder on next page(if different E-Mail: D 07. u 1 1, C D• C'6WI
from the Owner listed above) State or County License: LC D
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTA! CO.NSTRt1CTIN LJENLAVI/.INF,ORMATION '} t �{ `�
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: 4 Address:
City: State: City: State:
Zip: Phone' Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: I V 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.co.ncurrency review: room.additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses toanother 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.
Tiglfure of Owner/ gent Lessee §ignaturVof ontracto License Holder
STATE OF FLORIDAln- STATE OF FLORIDA
COUNTY OFS� hC.cc.lc7' COUNTY OF 6% 4Acc.i,,z;
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�sday of 20L by this o`Z(a-day of u 20� by
(Name of person acknowledging) (Name of person acknowledgi )
( ' natu a of Notary Public- tate of Florida) ignature of Notary Public- a of Florida )
Personally Known OR Pr _ u e Id ntific ti , Personally Known OR Pr duced Identification
1 .
Type of IdentificationPYod Type of Identificatioh�rod e
cSy ` _ 4�,,22 C '""r'a''. DUELINE HDADLEY
t{qr� o; �Isetlictate of Florida k `'. oa�� Notar Pub i�te of Florida
Commission No. :�=•(y �1 ° Corr(rSeai�n# FF 942489 Commission No. 1P'Z�(Z' y �sea�l
�� y Z,�f�j. •' "mac= My Comm.Expires Feb 12,2020 _ Commission#FF 942489
hFOF FIG �;-Mv�"omm. Expires Feb 12,2020 Ft
. Bonded through National Notary Assn.
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