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ALL APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ( I Permit Number: tJ-
0 155
�_. .� .`.. .._ Ai RECEIVED
Building Permit Applicatio MAY 0 4 2018
Planning and Development Services I ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential —vim
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 33D5 SRbNWrJbb 1116"Lk'
Legal Description: S ]UX)n/'!A dt",e _ PLg7 TlvO 13Lk 'd0-L67 73 (OR 90'JO-- M,5y)
Property Tax ID#: 3qd5,- 16Q- J q/7- rJUU - Lot No. 3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: M [ lQ
CONSTRUCTION INFORMATION:
Additional work to ff
Orme un er t is permit-c ec a appy:
HVAC Gas Tank Gas Piping Shutters ❑Windows/Doors
❑Electric ❑ Plumbing Sprinklers Generator Roof if �� Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: �� y/3
Cost of Construction: $ Cod WD Utilities:[]Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: 6, /fid6-gA)
Address: _3c_�C$ _77 'm CuBoD AuP-1ruL- Company:(7/qt,'Dr )/gt-RtDFTj7t,,, eSTI�t�G
City: Pj�r ST LUCT4 Stater Address: /bbl _S� 5 A� EI'nEy�� C'I1QCL�
Zip Code: S/g59 Fax: City: Pbu Sr LaLtE State:-f-6-
Phone
tate:_Phone No. -77a -_33L- &)?y Zip Code: \__5Vg59- Fax: -17,;1 -33T-gl55y
E-Mail: Phone No. -77a- 335-335- q 5D
Fill in fee simple Title Holder on next page ( if different E-Mail: L�: eOt')At WU)01I(r, 6,r;Vl
from the Owner listed above) ate or unty License: .3
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 thepermit 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 our Notice of Commencement.
Sign#`re of Owner/L see/Contractor as Agent for Owner 41rinafure of Contr/actovvlcen5e Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,-jT COUNTY OF LUOX-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 01day of /t'I'990+ .20_L� by this 2&Oay of 11 -J Z.C14 20_L? by
44, �,CA� S. NI��i9ry
Name of per5orifnaking statement Name of person making statement
Personally Known OR Produced Identification�_ Personally Known_rte OR Produced Identification
Type of Identification Type of Identification
Produced e.0YPOe,. DENISE LEMAY Produced DENISE LEMAY
# *MY COMMISSION#GG 077376 * *MY COMMISSION#GG 077376
EXPIRES:March 23.2021 N EXPIRES:March 23.2021
19jFOF P. Bonded Thru Budget Notary Serves ��Fo .c Bonded Thru BudpN NWary Services
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. G 0171 2' , (Seal) Commission No.6e, (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17