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ALL APPLICABLE INFO/MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `X• l Permit Number: i l
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Building Permit Appliealtidn
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 ed of line
-P.ROP.OSED IMPROVEMENT LOCATION; : ..�.� .1
Address:
Legal Description: u '� C0�'r`�`p'�t~,S p>t'� .rte f Girl l O
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Property Tax ID#: �7 _&:1 CPLot No.
Site Plan Name: Block No.
Project Name:
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Setbacks Front Back: Right Side: Left Side'.-
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DETAI'!ED pESGR'IPTION OF WORK:
cam' //u)Arl'CA,Yl,�2. .�"1�, -e S- �f`e t it
CONSTRUCTION INFORMATIOW,
Add3
itiona war to e e orme under this permit-check a pp y: 1' .
HVAC Gas Tank OGas Piping _Shutters i 11 Windows/boars
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: — Sq. of First Floor:
Cost of Construction:$ o� q I� _ Utilities: Sewer F]I eptic Building Height:
OWNER/LESSEE; CONTRACTOR
Name u c f.-e—n YVl • Name: t' V•i S_ hA
Address: 14ZtO Company #--r. a Y�
City: V:;- f State: Address 0" l-A -
Zip Code: -3 4'' Fax: City: q!` �� 1= State: �L
Phone N Z ' yg Zip Code: i Fax'y�
E-Mail: �-u�Q Y' `fig n- Phone No. -7 'S
Fill in fee simple Title Holder on next page(if different E-Mail: U.41r tz 7l S I1 erS p�C-�
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from the Owner listed above) State or County License:
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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'SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATI0N
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City' State: City: i State:
Zip: Phone Zip: Phone: i
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FEE SIMPLE TITLE HOLDER: —Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address: 1
City: City: I
Zip: Phone: Zip: Phone: I
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 per hold r,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 a`ny restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that 1 will,in 611 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 ladditions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another cion-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
commencin work or recording our Notice of Commencement.
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Signatuur of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF CA ,c__o COUNTY OF S1
The forgoing inst ment was acknowledged before me The forgoing instrument was acknowledged before me
this L day of�ese..._ ,20_] by this 1�-day of_ �?' ,20�] by
Name of person making statement Name of person making statement
Personally Known- ' OR Produced Identification Personally Know`n�. OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature of Notary Public-State o lorida) (Signature of Not4y Florida)
Commission No. (Seal) Commission No. (Seal)
s'\.sem .•, -- .',o< ,'4.
Rvn��{�' !6 SHAHNA 1NGRAM, � � ¢" "� Notary P 6tIC=Sfatn nr+Yl
REVIEW NTOrary;'1ZQNtN�G,ar N)1[0-,SUPERVISOR PLANA ="- G t AT10 m. ESE MANGROVE
T E 'd MANGROVE
T, O NI'ERom+i.RE)/I INREVIEW REVIEW "' or IE commis srorR.E1flE�/U '��' t' REVIEW
2C 24 ?ntsir: as a,,,• i.
DATE "'On ff fF j7 1 "Yw�w � U �� t l7Jd0
J Bonded thr ugh Natrona 7` 9 ft �' g Niionat Notary Assn.i
RECEIVED' V h _ I Notar
DATE /Is
COMPLETED
Rev.8/2/17
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