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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6 . Sc. I k Permit Number: 16
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lirimminsiisimmemissmusio_ .. .:..eBuilding Permit Application
Planning and Development Services MAY ®$ ?018
Building and Code Regulation Division Pem►itting pe
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie caunrtyent
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential iL_
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATION: nn
Address: g.7 S c'- //f 6-c- Z./z, ,, /± 4-i- Pi/7-4 c,-----: , f/ 3 `/9 c/4_
Legal Description: Ay Givrce)`:,v4 �f /;/s?,t<<! i'L/< c' LuL' ,2../ . , f,--- /2 ,,,,„e/3
Property Tax ID#: 3 // G 0/ - O ob 2' - 4-2c.7,-7/7Lot No.2 /,3
Site Plan Name: Block No. 5-
Project
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION
Additional work to be pertormed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:' ,
Name ��. .� f.c� fidv Name: ����
C9&•,-f✓ tom
Address: 6 7 S-k- /0 v<a 4c, Company:
City�'it 1- A .r 4.i= State:ic( Address:
Zip Code: 3 c/� Fax: /✓/A City:.. State:
Phone No. 772 _ 33,.- t/zicf Zip Code: Fax:
E-Mail: .5.P.0 v 5"-./l`/0 /go/ , c,,,/y� 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: o• 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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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.
Signature-of-Owner/Lessee/Contractor as Agent for Owner-' Signature of Contractor/License Holder
STATE OF FLORID}. STATE OF FLORIDA
COUNTY OF SS�--� C�_ COUNTY OF
The for oing instrum nt was acknowledged before me The forgoing instrument was acknowledged before me
this $-day of 20 \ 'by this day of ,20 by
hOftY) r•Li\Otr-4—
(Name of pers.a acknowledging) (Name of person acknowledging)
/
(Sig ature of Notary Public-State of Florida) (Signature of.Notary Public-State of Florida)
Personally Known OR Produced Identification � Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced l�� �—�� Produced
KAREN S. NIELSEN
Commission No. ';eiVEStatgafiorida-Notary Publi ommission No. (Seal)
Co mission #GG 207484
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4,Fo111�0`, My Commission Expires
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Iev. 7/2014