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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r ' p
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
- -Address: Clio lay COU r+
Legal Description: K�Qc,c Pc,(-k-
Property Tax ID#:3u l9":5L•O Lot No. Ko
Site Plan Name: Block No. 5
Project Name:
Setbacks Front Back: Right Side: Left Side:
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itiona wor to e e orme un ert is permit—c ec a appy: x
HVAC' Gas Tank ❑Gas Piping _Shutters �Windows/D_cors
Electric 0 Plumbing Sprinklers -�Generator �Roof -" -
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 3591 -29 Utilities: Sewer E Septic Building Height:
Name_K`/Q n G<te-W-C t r.I_TFP_+4_ -TIi(6014AII Name:
Address: 9onjQ CC1(frt Company:—,T-4-co
City: 02't SCl-,cj� L xj C. State: Fr Address:
Zip Code:3 41T9 3 Fax: City: LO-.`ffi kn!j r -,C k State:_
Phone No. .303 -7_)$ `6691C13 Zip Code:33L1 1 a-- Fax: 51,1 . S•C/o) 5
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(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.
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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
commenciot work or recording our Notice of Commencement.
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SilKaaiure of Owner/Lessee/Agent naturdV Contractor/License Holder
'STATE OF FLORIDA STATE OF FLORIDA,
COUNTY OF COUNTY OF RIM &n C l7
The fo oing instrument waif efore me The forgoing instrument was acknowledgedI
foreme
this day-of �� 20by this day of 20 lby
(Name_of person acknowledging) --(Name of-person acknowledging-)- _
(Sinnature'of Not4 Public-State of Florida) (Signat of Not Publi tate of Florida)
` Personally Known i/ OR Prod u Identification V Personally Known v OR Produced Identification
Type of I _gntific Type of Identification Produced
sK►.. SARSAFIAJ NE COCK r
Commission No. 3 C E 11 Commission No. UNG
+� EXPIRES:Octobrr$2020
My COIN ISSION 9 FF 951069
a'r•• o�•' ���e�� o EXPIRES:Avil 12.2020
�� t QF 91.9- Rngw 77rw Budget Way 9erAces
Revised 07/15/2014
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