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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / J t-,�
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Date: Permit Number: �� �
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COUNTY : 101019 a/•y/�1 't(
_LL O.'R hi, D f_ P i n .6)`4I/? ` /69
Building Permit Application @ ��menr 'CeCo,./1`,7,pd
Planning and Development Services '4,ie4t
Building and Code Regulation Division
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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
PROPOSED-IMPROVEMENT LOCATION: '' _ '
Address: 346 ? Sk,c ri litZA
Legal Description:
Property Tax ID#: Zi-105- I lS- (:)(NZ' 0���- I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
'DETAILED DESCRIPTION OF WORK ,
Q-QA1-61`0At6 6C-C- t n eCL `4- itQctdca r `vSc- Cc
CONSTRUCTION INFORMATION„ ._ ,• f
Additional work to be performed under this permit-check all tha apply:
❑HVAC Gas Tank nIGas Piping Shutters QWindows Doors
—
14 Electric 0 Plumbing l Sprinklers III Generator El Roof Roof pitch
Total Sq. Ft of Construction: Sc. Ft.of First Floor:
Cost of Construction:$ 9.0v• 00 Utilities: Sewer ill Septic Building Height:
O101ER/LESSEE '' i ' " '. l ''CONTRACTOR: ; , . '-'.
Name-NI-6AWM ;Abyn.12_ love.5 V 1 Name:
Address: 33 l.\ p,J ZOCI, T- ..A.nr Company: c 3a-„ C C ��) Q
City: �_i(Y\.% Q n S State:-� Address: l ,.D CO r1.40.c IgG1
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Zip Code:33O5(P Fax: City: -R--. L_ State: F 1
Phone No. Zip Code: 3L-tq S2 Faxa l�-L4vC( -"4(Ss
E-Mail: Phone No. i12-L-�,Qk-S-32.�
Fill in fee simple Title Holder on next page(if different E-Mail: S g cuA, Gvvi
from the Owner listed above) State or County License:ECit'IDCX1443
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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 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.
Signafr� o Owner/Lessee ontractor as Agent for Owner Signatu - ,f Contractor/License older '
STATE OF FLORIDA, . _ STATE OF F COUNTY OFORID� L(��
COUNTY OF
The forgoing instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this CXday of � --,20_ by this ay of f-'LA4 ,20 N.-by
Jam` 2"s ' _ 11 -- s
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Prod -d Prod c d
( J. C� N-4,
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(S gn re of Notary Pub�L State of Florida ) Yignature of Notary P.blic-State of Florida)
om ission No. (Seal) �f,, Commission No. (Seal)
1,,INGRAM
GR V,zin; , of Flo % i
_ SiiAl-1NA IN Flo iu
11++ LIVS at ric ', �"- f- _ i��. 20 ?l V ,
,4_____.,rug,:; Fl°:8fv i 3G 2U C / , '. ia1) i,°
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REVIEWS FRON' ��=20NtNG�� SUPERVISOR c' PLANS VEGETATION ,� E' , RTLE° 'S �IGR:Q�2ffv iusr.
COUNTER•r REVIEW , 4 REVIEW,' -REVIEW REVIEW ',%Ii;E 'ItMondedlir VIEW"
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DATE ;,'t .� =-- _
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RECEIVED ---,..-17-;,-----:-/-
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DATE
COMPLETED
Rev.8/2/17