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Date: J ' I Permit Number:
71-r .
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M119 aw RECEIVED
Building Permit Application JAN _ 9 �0t8
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County
Phone: (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: l �� I_aS 6 la p►�i� , �TP�-,�S s c_ln, F I A 2!2H
Legal Description: CA\U\o Q-1 M�q �P(' _ (r�j�� Un R
Property Tax ID#: �-{J(� ' (�- _D� - Lot No.
Site Plan Name: 0 IDQ Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
eve e �`Wc - , very c n
'�I;
CONSTRUCTION INFORMATION:.
Additional workto a er orme un er t is permit-check aMa
❑ ppy:
HVAC Gas Tank [:]Gas Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: ( S . Ft.SewerOSeptic Building Height:��
of First Floor:
�
Cost of Construction: $ 1 256. 6a/6o Utilities: I
OWNER/LESSEE: CONTRACTOR:
Name rot& M XS C1_1 Name: Clc)6iCCS
Address: IDI rJ In s oda s DKIV-e- Company:
City: aein 4n be-a h State: FL Address: _�j_jL1 I S6_ 51Q.}eX
Zip Code: 3t-Iq'5�1 Fax: City: S-tyCLY-+ State:�L_
Phone No. �l 2- 9 85- ao55 Zip Code: 3LtgP-7 Fax:
E-Mail: -Y�Q, Phone No. 1'l2- -2_271-2 2 2�
Fill in fee si ple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License: rCC I �CO6-7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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:
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.
f
s
_Signature of Owner/Lessee/Agent Signature of Contrac r/License Holder
STATE OF FLORID STATE OF FL RID�A
COUNTY OF �Cu.�V7 COUNTY OF U,4i in
The for oing instru ent was ackn wledged before me The forgoing instrument was acknowledged before me
-this day of 20by this�day of 20 by
(Name of person acknowledging) (Name of per on acknowledging)
t
(Sig re of Notary Public-State ofur
a) (Signatur)of Notary Public-State of FlorQd )
Personally Known OR Produentification Personally Known OR Producedntification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
_° REBECCA RESTIFO
Revised
,Y,cpMMlssloN#GG91863 g
qw e� 'RES:May 17,2021 N� MY COMMISSION#GG91863
,c OF Flo /�.OF °PPT EXPMS:May 17,2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS