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ALL APPLICABLE INFO MUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED VOA
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Date: 4426-/Y Permit Number: I
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COUNTY' RilleC ®
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Building Permit Application 'SPR 26ipp18
Planning and Development Services Pew!
Building and Code Regulation Division St Luc! e
2300 Virginia Avenue,Fort Pierce FL 34982 p ,elm.
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential le
PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
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Address: 90 M-7We 4'iYQ J ill! ,� C' 0a 4 l 3yp 57
Legal Description:
Property Tax ID#: 2-Jv/-/L/'7 / -coo- Lot No
Site Plan Name:( e-pr"1'/ CFS^ Block No.
Project Name: II
Setbacks Front Back: Right Side: Left Side: I�
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION: •
Additio I work to be erformed under this permit-check all apply:
_HVAC LI Gas Tank [IGas Piping L_I_Shutters a Windows/Doors
aElectric ❑PlumbingLI Sprinklers �GeneratorIII Roof I Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
7-� C
Cost of Construction:$�J/?..1007.-- Utilities: _Sewer DSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 1 Ji t II I N '... ti.6 `.., .% Name: (C rL J
Address: �")� k t�` a!I , I . Company: �CAvkS `, , �M 1 l l�le..
City: ,1 1 l ►� �I State: Addrs: Svc �i 4.v� 5 In
ZipCode:(3\051 Fax: l,` City: 1 "1 • LAC i e___- State:frt.--
Phone
jPhone No. q )- 7 - _ ,... Zip Code: X1WFax:kW
E-Mail: k li Phone No. tThfrint.(5:1(-66
Fill in fee simple Title Holder on next page(if different E-Mail: C‘ft,MSe, a civ(`(A (lest
from the Owner listed above) State or County License: %1,45°IO
I
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:
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 confliru
ct 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, I
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.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF sr4.. leve- COUNTY OF . a4v. -
The forgoing instrument was acknowledged before me The forgoing instrum nt was acknowledged before me
this u day of ,20 IS by this day of .1 ,20 by i
r__44tn...1 uM«es E1 d OS ,*_ AA w.as elvJood CS Lee--
ame of person making statement ame of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identifption
Produced FLI C> r Produced
_ N _ 1 .
(Sign.ture of Notary Public-State of Florida) (Signatu e of Notary Public-State of Florida)
...... .... ... . ..
Commission No. ' .��'o���e�", KAREN (Sei3l)E L S E N Commission No. °,,*'0"° Y I<A k2 E74: (E L S E Ny
I.,* di *_ ommission i FF 115637 1 c ?''' *= Commission# FF 115637
s....,016,,,-4.7 My Commission Expires N9r o; My p
Commission Expires June 12, 2018 n,
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGW(� E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17