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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1 71 1) 2 o ✓
4 •:
Building Permit Application OCT 12 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
PERMIT APPLICATION FOR:
PROPOSED INPRC+7UEMENT LOCATIO' .
Address: ,5'26' Z c e� Az,
.Legal Description: 0ee-c't n &U`^ S GGeAprr.J��-9-.,Sr' ;Js
Property Tax ID#: //4 -5"o'2^a 1900& Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side:. Left Side:
DETAILED DESCRIPTION aF WOR!Ae
K:
a-fit ee- - � 9 F
CONSTRUCTION INFO MATION:
Additional work to be performed under tis.permit—check all that appy:
_Mechanical Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers. _Generator k0"Roof Pitch
Total Sq. Ft of Construction: %j Sq. Ft. of First Floor:
Cost of Construction:$ v17 Utilities: _Sewer _Septic , Building Height:
01NNER/LE-�SSEr : CONTRACTOR:
Name Gcy,� `� ✓ Name: a �" �,X
Address: 1111191`114-1— Company: ' '(A� 11dWe/
city: (f Wc`�/Lf / State Address:
Zip Code:�-S�eif Z9/2J' Fax: City: State-It:--:/
Phone No. —2 2�-- . � �i76 Zip Code: i��'r!� Fax:
E-Mail: Phone No 7X— Z6,(— !?_';2 -L-
Fill
LFill in fee simple Title Holder on next page( if different E-Mail oZ l egg? _.
from the Owner listed above) State or County License Cf?C-06 57 Of
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i
fPP EMENTAL CONSTRUC�TI®N l.l� . LAW I,h1F®RMATION�.
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.
Al
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Signature of Owner/Lessee/Contractor as AgentlFar J rvr?e Signature of Contractor/License Holder yx N
°fay 2'
STATE OF FLORID _� STATE OF FLORID i 2
iU
COUNTY OF � I COUNTY OFL a
M 60 .0
r2 ` r The fo oin —�
The forgoing instru ent was acknowledged bef �Ie�m`�. �� � g instru ent was acknowledged befor ri � e
this day of 20 by ¢z� 0 this day of 20g by ¢�X
eb)212 �w m
O: C -V4ni4)
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Name of person making statement. _ ` Name of person making statement.
Personally Known OR Produced Identifi r- Personally Known '-'OR Produced Identific a uk y
�t
Type of Identification Type of Identification
Produced Produced
12f daw, ZA
(Sign ure of Notary blic-State of Florida ) (Signature of N y Public-State of Florida
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17