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All APPLICABLE INF
O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �e
Date: Permit Number: /Y1-1 — ��'
C40 JFT
F L D R I DAL
44
itiiiiiiNimmilifolioo Building Permit Application ®4
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Pianning and Development Services and Code Regulation Division 8f,�"99 9 Cn
BuildingDimer
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 4/
PERMIT APPLICATION FOR: adZtl,
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R®P EPAR®. UMENTLOCAION .� r ] r fE Fj £ -.,Art
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Address: �„c105 • oe..,05cr �i 1 f2C'vc-( it .25/1,cJ
Legal Description: r(JJ ,
Property Tax ID#: in, //J— 11613" 000/- C40/0 Lot No.
Site Plan Name: Block No.
Project Name: .
Setbacks Front Back: Right Side: Left Side:
DETAILED DES:CRI'PTl®N OF W®RK f _ x °a'la {t t& °; ti 3 , 1}
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a�,u,. !," �.:,'1Asu. �'i1 .uw,,Lk_6;.1 i, "a:-, ax.�, 4a;r .-''� .,r�..:JE,s:', r%L'.. ' _` tato J -r+Er =
i fiA/i,:,-,5 SG,( feS aver 54ie-9 - ...›X• S
CO_:NSTRtJCTION INF®RfMATI®N� � � �a. , ;4 n,�� , z 2
.._. ._ s. ..$3 . . a ;may ,
Additional work to be performed under this permit—check all that apply:
_Mechanical Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof `:f S Pitch
Total Sq. Ft of Construction: r 057 Sq. Ft. of First Floor: . I. (3 ,
Cost of Construction: $ 7 S('I Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE .g t j ' CONTRACTOR ' :i ,FY a
.72
Name lktgt!7lfl-C./ A-til t0 5 AlName:
Address: / C?OS ,03 ,...„5 v Company:
City: fD ft 0 lC F'G( State: 15" Address:
Zip Code: '3 6 U ( Fax: City: State:
Phone No. 7 762--;-,01- —6O/ 7 Zip Code: Fax:
E-Mail: firIo-St-nMel 7s-co?00.114If. COQ Phone No
Fill in fee simple Title Holder on nexpage( if different E-Mail
from the Owner listed above) State or County License .
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPplg CONSTRUCTION LIEN DM INFORMATION; ; : ,
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
MN
me: -..._._..-. :. —
ame:-
• 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 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.
f ; -
Sigyratu of Owner/Lessee/Contractor as Age 1.01504)y. .er Signature of Contractor/License Holder
_e,` [ .�_
- IR : .a=
"` STATE OF FLORIDA
STATE OF FLORIDA e s4.4—.i:,F.
COUNTY OF St• ��" • COUNTY OF
The forgoing instrum nt was acknowledged b�fcIrT ie Y. The forgoing instrument was acknowledged before me
this day of. /(L i 1 , 20 IgA �� this day of ,20_ by
��� YYYYYY d ed II'
Ri4e/
(Name of person acknowledging) 1 7811 (Name of person acknowledging)
f. .
(Signature of Bary Public-State of Fl:ida) S (Signature of Notary Public-State of Florida)
0.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced /=L//: Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014