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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:Permit Number:
~il!"J~t:.~..--
Building Permit Application
Planning and Develapment Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 4Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:To Select from dropbox,click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:.
Address:B~()'b 0lCl\(¥(tld WC\tt
Legal Description:\J()d a1 t2 \VW ftj'C?'lvt fl\l\'Y£i ~tc\rt~~~,lot ~5 (01 J.3S0 ~an3j
Property Tax 10 #:J:3 9-B -Boa -()O'1~-COO --LP Lot No.
Site Plan Name:Block No.
Project Name:
Setbacks Front Back:Right Side:Left Side:
I DETAILED DESCRIPTION OF WORK:I
:IJ\')\'o{)f\~W 50~<i\1Q\e,Wlh ~r<\.0-\l\;:)Y\l'\ofFVo-hJ e·
I CONSTRUCTION INFORMATION:
Aaaltlonal work to 'r prrormea unaer tnis permit -cneck all Uapply:o Windows/DoorsDHVAC_GasTank DGaSPiPing _Shutters
DElectric ~Umbing Dsprinklers D Generator DRoof I I Roof pitch
Total Sq.Ft of Construction:S8 of First Floor:
Cost of Construction:$\\1 ()()Utilities:_Sewer D Septic Building Height:
OWNER/LESSEE:CONTRACTOR:•
Name k<\l'YLl (}()C)(\Q{'Name:\JOVi C\:'J()C\lcl))1(1
Address:~:':D<n 'r'Yl\..Uy·f\~\dLJc\.\.\Company:]b<l ~l'~MI2(r1~kb<h~lilt
City:\\~k State:Ft.-Address:34]'3 jW ct\(o p:e jl:--
Zip Code::')t~q~LQ Fax:City:PJb.<State:£L
Phone No.Zip Code:34QS3 Fax:
E-Mail:Phone No.11~e ~z..7~1 'J....
Fill in fee simple Title Holder on next page (if different E-Mail:\\tLe.~,\vrnb\~~2 h'iC ~8Mci.l.Con1
from the Owner listed above)State or County License:~FC-14~84'9
If value of construction.is $2500 or more,a RECORDED Notice of Commencement is required.
SU PPl;:EM ENTAL CONSTRUCTLONUEN LAW INFORMATION:'
>.<;:---'",.-e,,-~.-~~--,'"-;'>~{iY';"-~;,-,_''.~",-.'-'''_',-",-:'-,.
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:
OWNERI 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 structurewhichisinconflictwithanyapplicableHomeOwnersAssociationrules,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 vour Notice of Commencement.
STATE OF FLO~~COUNTY OF ,L
The f~ing instrmas acknowledged before me
this day of ~,20J..:l by
"----Personally Known OR Produced Identification
Type of Identif~ig.Q.
Produced ~•·.....U.A--
DATE
RECEIVED
•••••••••••••••s~e'%::OJU~:-'
STATE OF FL°ltA Vv.COUNTY OF c.i..
The forgoing instrument was acknowledged before me
this 3.c day of O'--h I::>c-,20i:}by
:DalAl.'~MhtanNameofpersonmaking's
Personally Known OR Produced Identification _
Type of Identification ~r»
Produced,~r-~__~__~_
MANGROVE
REVIEWCOUNTER
SUPERVISOR
REVIEW I REVIEW REVIEW
DATE
COMPLETED
Rev.8/2/17