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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
• RECEIVED
Building Permit Applica tion JAN 2 6 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: " c `a
PROPOSED IMPROVEMENT LOCATION:
Address: ei _02_ Ford" Pierce Bl vol, 'Pl Grc _ r-L 3 f c15 1
Legal Description:
Property Tax ID #: 130 1 - &C79 — 01 `+o — 000/ 6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: C� FY-1st-'PiT--:[-1( !�, 1 c�
-STRIP O'.- S 1 fi> I Iv b M (,-)Q_
1/ At P O R RJ A re R I G+�C+
l.(lAer e+,v 1- !1 P�( tQn'm TI-"r ( S StulVt IeSS ��V] cSL14y/� vial"
CONSTRUCTION INFORMATION:
Additional work to be pertorme 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: I I ^-gO Sq. Ft. of First Floor:
Cost of Construction: $ 1'300 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name S(tiZCknlne Ness
Name:
Address: I 5`2-1 5 22 Sk fJ
Company:
Address:
City: 1'()X0 A 'Pre State: _E�
City: State:
Zip Code: 3 3 W7 d Fax:
Phone No. S (0 1— 210 +_ 3 5 0
Zip Code: Fax:
E-Mail: S u e ne sS ?,(A. 6 q 0041 • C 0&
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
� SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:,
Not Applicable
State:
BONDING COMPANY: _Not Applicable
Name:_
Address:
City:_
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
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 your Notice of Commencement.
Kev. 7/1014
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S �-. LO- %-"Z,
COUNTY OF
The forgoing instrument was acknowledkeqbefore me
The forgoing instrument was acknowledged before me
this Z-S� day of �3 °vim 201'A by
this day of 20_ by
S \)Zg � V)t 53
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of NotaryPublic- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced L L _
Produced
DE -ANNA MARIE GIVENS
Commission No. = SION#GG 422023
$ MY(�Q>r�l
Commission No. (Seal)
a3 EXPIRES: erember 16.2420
,EWkb ' Bonded Thr i Notary Public Underwrite �'
REVIEWS
FRONT ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 7/1014