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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 'y
Date: Permit Number: QUSJ' v!
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I � 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
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PERMIT APPLICATION FOR:
IPItP SEd1 k P.�
Ewm ' �AkrTIvrt
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7 3.-1 P�� e
Address: .
Legal Description: S� ��1Ipj4 c &
Property Tax ID#: a ° 60)- 00J(o OQQ Lot No.
Site Plan Name: Block No. R
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET�A•LED DE��.�ri� �{�N.''' F il1IC�R -. �� ��� � �, ,;� u � �M
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Additional work to be pertormed under t is permit—check all tat appy:
_Mechanical —Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric F-5p—1umbing —Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
G j
Cost of Construction:$ 1 S `� Utilities: —Sewer _Septic Building Height:
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ERL.ESar �� C1R: a . k
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Name k1 v+ �— Name: 1 ,eY100�D _
Address: 7_� E2e S-eyae- C Rt-e. J) Company:
City: 70 5 L State: C Address: 7 Z S` S G er,: i✓/L'
Zip Code: 3 `�l g� Fax: City: S State:.
Phone No. Z Zip Code: - Fax:
E-Mail: Phone No '7�2 3 70 //s
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
Ifvalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
R E € I GC}NSRI'C�?t I»! N LAW INS RMATI
n ;
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 conflict with an pplica'ble Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult h your Home Owners Association and review your deed for any restrictio which may apply.
In consideration of the r nting of 'is requested permit, I do hereby agree that I will,in all respec , rform the work
in accordance with th a proved ns,the Florida Building Codes and St. Lucie County A endm nt .
The following buil ermit a ications are exempt from undergoing a full concurre y revi oom additions,
accessory struct r immin ools,fences,walls,signs,screen rooms and accesso uses t other no -residential use
WARNING T NER: ur failure to Record a Notice of Commenceme may cult in y r paying twice for
improver s ` your operty. A Notice of Commencement must recor ed d osted on the jobsite
before th fi st 'nspectn. If ou intend to obtain financing, consul ith 1p de r n attorney before
commen n rk or co ing your Notice of Commencement.
iVA .IVI
Signatu OwnW/Lessee ntractor as Agent for Owner Signatur f ntractor/License Holder
STAT F FLORIDA STATE OF FLORIDA
COU OF COUNTY OF
The fo oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 200 by this`) day of 201 by
',Aco%�
Lrson acknowledging) (Name of person acknowledging43Z
f Notary Public-State qoorida) (S1gFdturb of Notary Public-State o rida)
Personally Known OR Produced Identification - Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
� ,, LA, AN"'A INGRAM
Commission No. .���°R,=�a�-, eat) Commission No. Y„� Si-(Sea0NGRAM
Notary OcVic-State of Florida {PA �a'�
(s °z Icy Comm.E:.pires D:c 20,2C i 8, f '= Notary Public Siate of Florida ..
\° a �4 s8 Iti tp %r 1� nr,v comm.E>:oires Dec 20,2018
;F o C��� u'aoiun =rr irizti! a+a pp *p Commission it
y� FF 177249
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Figie r r ighNafo^^ .t.< ,A°a F' SEAeTURifrLEhNa IVIA'N'GR E
REVIEWS FRON-Ty-.,:TZ ��. S rR PLANS VEGETATIOfS,,,,,� _
COUNTER REVIEW REQ REVIEW REVIEUI/ .= x:REVfEVU`=.r REV(E�IV '
DATE
RECEIVED
DATE
COMPLETED
iev. 7/2014