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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4 Permit Number:
- ' ,'
tsunaing Yermix Hppiicavon
Planning and Development Services
Building and Code Regulation Division
23oo Virginia Avenue, Fort Pierce FL 349182
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PHOPOSEU IMPRU_V_EMEN l LOCM ION:
Address:
Legal Description:
Property Tax ID #: y��� /�� Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
L)E I AILEV L)EKRIP I ION OF WORK:
/te 14-r 01,fe- �'�.� /, Sec( C� %Asc- D1�
c� I
CONSTRUCTION INFORMATION:
ona wor o e er rme-3 un er is permit - c ec t a appy:
HVAC 0 Gas Tank []Gas Piping _Shutters
11 Electric Plumbing Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 3d _0,__
OWNER/LESSEE:
/o/tk.,-'
Sq. Ft. of First Floor: _
Utilities: OSewerOSeptic
Address: JyGG' [�/71in���u'z�! rr, �v�oa� -_-
City: _ f a Ala- hl c_State: �L
Zip Code: J�3 f f - Fax:
Phone No. 7'7d Li //&o
E-Mail:c nsf ooL r. vi i� a -P & ALtt. TIL
FII in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
QWindows/Doors
1-1 Roof Roof pitch
Building Height
Name:
Aey&Aen,
Company:
Cu37om A
Address:
1 �i' 15 1%; 11 da - �e i1 Q
City: Po P -r 9t. Luc( e_ State: r�
Zip Code:
a`'F452.- Fax: 771 J 35-1 5142 �
Phone No.
i 'l a 335-313)_
E -Mail:
eK 8tC,Ir s; I ccc,l (C,vn
State or County License: C°.,q C c? 5 ( 1
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEM EN I AL C:UNS I RUC l IUN LIEN LAW INFURMA I ION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: Slate:
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:
I certify that no work or installation has commenced prior to the issuance of a permit.
St_ Lucie Countyhich is in . makes no representation that is granting a permit will authorize the permit holder to build the subject structure
Association Owners may restrict or prohibit such
covenants ctions
aws or for
which may ahat
structure. Pleasecconith sult with your Home Oe nners Association ndrrev ew your deed any restril.
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 pians, 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, wails, signs, screen rooms and accessory uses to another non-residential use
WARN ING 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 your Notice of Commencement.
t r
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Con raco/License Holder
STATE OF FLORIDA (, STATE OF FLORIDA
COUNTY OF COUNTY OFt
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 l by
this day of _7_4 20 ribtir
- LrU r 1` I; � PYl mon S �cc (STI S gil r'vl MCI rA S
(Name of person acknowledging (Name of person acknowledging) j
(Signature of Notary Public- State of F[ a) (Signature of Notary Public- Stat o4FIori
Personally Known ✓ OR Produced Identification Personalty Known OR Produced Identification
Type of Identification Produced_ Type of Identification Produced ;
Commission No_ Ui G7 5� L1 mission No. C'1 �7 � � c�S�1 t' � • • rw;: a. .
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EX—PRRES: Apri , 2021 _— S MUSHMy
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Rexrised 07/15/2014 T, E)SRES: AM 4, Z21
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW ! REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLETE
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INITIALS