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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED aa ,
Date: Permit Number:1
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4W \ PNR*MINNOW Building Permit Application;
Planning and Development Services ( ;
Building and Code Regulation Division
2300,Virginia Avenue,Fort Pierce FL 34982 3{
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Phone: (772)462-1553 Fax: (772)462-1578 Commercial l Residential
PERMIT APPLICATION FOR:
'713-
AddreA
ss: V7 N town L V1, i:-r. Pi cru.
L Igal Description:
Property Tax ID#:6410. 500• ()()6`. ()CC)� Lot No.
Site Plan Name: ilt' Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: I
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Additionalwork to be pertormed under this permit—check all that appy: I ;
Mechanical _'Gas-Tank _Gas Piping _Shutters hat i Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof Pitch
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Total Sq.Sq. Ft of Construction: Sq. Ft.of First Floor: V
Cbst of Construction:$ 4q ru.00 Utilities: _Sewer _Septic -!i Building Height:
j1 ii.4 1
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Name Name:m t FJ�f`
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Address: f7�1 �D0(a. ,�'!`� a, Company: j r a w
City: I;,r Pi&,qL State:h1 Address:^17{� !.S.c• i,
Zip Code: 371 Vol Fax: City: 1•.S. LdtlL State: rel
Phone No. ,�{ 7 e�df! Zip Code: Ili 16 Fax:
E-Mail: Phone No-77A 370 401(y
Fill in fee simple Title Holder on next page(if different E-Mail SiSbooit'y &L $4S'`�-ft L ^"-r.ocC
from the Owner listed above) State or County License
Ifivalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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�Sl1Pz 1: ME 7At.CQN, `RI C 10,, :I N I:AW IN URIVIAT[a1V
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-accessoryuses'to ariother 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.
Signature of Owner/Lessee Contractor as Agent for Owner ,Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 1,..�,,�� COUNTYOF
Th forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi� day of F!qk! 20R by this W day of b 20j3 by
(Name of person acknowledging) a (Name of person acknowledging)
(Is
ignature of Notary Public- to of Florida) (Signature of Notary Public-Staf%of,Florida)
Personally Known R Produced Identification. Pers'
OR Produced Identification
a 11=4
Type of Identificatio „��.� Type of Ide ifi�a �q,
;`t►a'"�+ LASHgHivA INIItIll1�1 Produced ,`�SrPbsi'a LASHAHNA
Produced `� ,
' •'='My Coy ublic'StaHularte of Florida : +''My Com'ublic-Sfate of Flori a
?r• Q,; m eS; . m.Expires
5 `�l... Dec Commissio o•. # pec dh
Commission No. o::: 1 ) 20,2018 mmttsion ��"''8
Comm Sion. FF 177299 ��h OF F4 ,o 177299
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Bonded through National NotaryBonded through Natbnal Notar
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REVIEWS FRONT ZONING.. SUPERVISOR PLANS VEGETATION_ SEATURTLE MANGROVE
COUNTER REVIEW` 'REVIEW REVIEW REVIEW "'=REVIEW 'REVIEW
DATE ..
RECEIVED,:.
DATE `
COMPLETED
Rev.7/2014