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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:l
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Building Permit Application'
PI lanning 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:
PRaPQSED I,N'PROUEM.ENT LCATIt}Nw, .
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Address: ��� � -P_ Cov-C L/J
Legal Description: 6e 4_, T'e'So4 Lri
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Property,T,,ax ID#: f tj - �-a2- 636 9- boo - q Lot No.
Site Planfi_ame: Block No.
Project Name: i Q_aw And
Setbacks Front Back: Right Side: Left Side: I
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DETAII:ED DESCRIPTIC►N OF
WORK ,I
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Gr-�r►o%L xG uerre U�;� �. �d�,/ ;W 1-1'Y3 6 6 o kTPOA
CONSTRUCTION INFORMATION g . a
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Additional work to bepertormed under this permit-check all that appy:
Mechanical _Gas Tank' _Gas Piping _Shutters �;. ' Windows/Doors
_Electric _Plumbing _Sprinklers _Generator ' _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic i Building Height:
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01NNE.R/t,ESS E: CQNTRACT',,, '
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Name 7: -2-(T �c G- Name: 7DU41;, iIi d 4 {c
Address: fS��' �^��� Gov �,✓) Company: %✓ y
City: Gc. Stater_ Address:
Zip Code: �GI9� Fax: City: vp/o �-e
c.y� State:r—e
Phone No. a9J- T9 Y 2l/ Zip Code: 3)_9?? i' Fax:
E-Mail: Phone No �7Z—
Fill in fee simple Title Holder on next page(if different E-Mail ��d 4 -cS/-( +. 04 �. CUN
from the Owner listed above) State or County License C A G /S2 k VO d
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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STICCNTRUI10UpPLEVNONt V
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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;-
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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 jobs to
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.
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Signature o er/Lessee/Contractor as Agent for Owner Signatu �n ractor/License n1dEr
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF
The fo�going instrument was acknowledged before me The for oing instrument was acknowledged before me
this 1S day of `N_15d 20—n by this day of 4�6 Y 20L—L by
(Name of person acknowledging) (Name of person acknowledging)
atu a of Notary Public-Stat&of Florida) (Signature of Notary Public-Sta e-of Florida)
• ti4GAARa1
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Personally Known OR roduced.Identification=-: P sonally Kno.wnn OR Produced_!& 't'ification3
Type of Identification „��,,, LA;HANNA ';` nc 2U,
,•• v ru''�. State°t FI°i Ty; e of Identifiatio Q<<s` [xPireS D A9
Produced .�'o`� s�%� Notary Public `,n Produced '2' °. `n�COmn,. F SF 172 A
fires Dec , ' otarY
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ission FF
Commission No. OFF�� �• ( onddthroughNationaltdo Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.