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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED V �5
Date:
13 Permit Number: i&TS v 3`1cS-
ggimilimmw Rec.,,..
• LINTY' rr., .- Mq
Building Permit Applications/777/45%o °1°
Planning and Development Services Eie�°nt°jeht
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:
9e,,00hy.i0),7
PROPOSED INPROVEMENT.LOCATION:
Address: 923 ,M#/es. l/vi J nie i fflee.G/i Pt. . 9-5'7
Legal Description: /R"_„th'S �S14"C/ the (11/,23-188E)
Property Tax ID#: 4/ -10,2 - 1O/- h O / "Q00-2 Lot No. 72 3
Site Plan Name: "/0 S Block No.
Project Name: 92-3
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK '
COm#0/e/e der4.92'i- 'o>, ill Kero a va/ o f i a ;k Ii o m-e hrJ
CQ/(de SJ4 Ond )4N/ori' a. r00)v1
CONSTRUCTION INFORMATION.
Additional work to be performed 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: 5 57 Sq. Ft. of First Floor: r
Cost of Construction:$ 1900.0o Utilities: /Sewer _Septic Building Height: ,/ t
OWNER%LESSEE CONTRACTOR:
Name A04ert 6-Cq-ther;ne 13vfft Name: % AP,'f1 ; J.
Address: 7 y9 t C're!/1/ C� Company:fir,�+ �n 1 f _ i caT e •In C.
City: Cf pf ier4e le/ State:$, Address: (6) ,/j!e. ) ,en'Pc 5>
Zip Code: y80 9 7 Fax: City: ,T nfen 8'ch State:/9,.
Phone No. 727" 3`/3- ,2871 Zip Code: 30/957 Fax:77,2-23,-)19/
E-Mail: Phone No 77,2-,2 SD -37J5
Fill in fee simple Title Holder on next page(if different . E-Mail ac orris"' "TA i✓ /c �yctheo• corn
from the Owner listed above) State or County License CBC /..1579'P/
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGIN Not Applicable/ pp MORTGAGE COMPANY: _ Applicable
Name: Name: -
Address: Address: ...-----
City:
City: State: City: —' State:
Zip:. Phone Zip:: Phone:
FEE SIMPLE TITLE HOLDER: Not App ' ble -SONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City:
Zip: Ph : Zip: \ Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a per i 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 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 re •rdin: our ► otice of Commencement. _
--A101.17-...e.--
Signat -e of Owner/Le .-e/Contractor as Agent for Owner Signatu of Contractor/License older
STATE OF FLORIDA _I___ STATE OF FLORIDA
COUNTY OF c`a'r—' COUNTY OF �� 1--' Lc --
The forgoing instrument was acknowledgedbefore me The forgoing instrument was acknowledged before me
this I Oday of i\-10.1."--- ,20 (6 by this (D day of J 20\.5‹by
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(; t V V
It '(� ,c) r-v\ a/1� l�l,�-lel Ct
(Name of person acknowledging) (Name of person acknowledging)
•
(Signature.of Notary ublic-State of Florida ) (Signature of Notary •ublic-State of Florida )
Personally Known OR Produced Identification _,;