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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �j
Date: S 1 ILA i l k Permit Number: 1 �-• .4 J0
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F L Cr R 1 D
Building Permit Application 41y2
Planning and Development Services
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Buildingand Code Regulation Division �f4,0p O�
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2300 Virginia Avenue,Fort Pierce FL 34982 Cof9 0
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED DNPROVE LOCATI® o . :: .
Address: /171 cJ orcin c_ Avz.
Legal Description: 9 ,3S ..9 Z`- (b 3. 6 7 r=-r- OF 'd 1/2 o' AA,/ t/41-LefS._
'i-C,r-Ncr C AS ; �. P6 72- 16 Ai)e1 Ir'' J I1J3 ,G7 �=t 0 .PS
0roperty'Tax ID#: 2S001''7 ?,3 Obn i OUei - Lot No.
Site Plan Name: R,O lemmc rend_ Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: i
DETAILED DESCRIPTION WORK?:. ..
_ 4c.i . ( I Pao l (Sokr,r:cr" Aium;inci' Rif).e.„ l h' + T- (1c,' # 1 .lav--.nr1�
-{�. fi G.•.1 Oe c k A2_6--c1.. , . C-et on (..)`cs1 canee c Sir.. Se c1 c
. CONST°UCTIOti. DEI1FORMATIONo .
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
t
Total Sq. Ft of Construction: ( `Z- Sq. Ft. of First Floor:
Cost of Construction:$ (i°(CCU Utilities: _Sewer _Septic Building Height:
OWNERR/LE=�S-�SEES . ..'... CONTRACTOR° v
Name (Z1 one) jA.ck \ N a me:,.cifte kkkv' IlS4^..Sk C
Address: 11710 Or i AveCompany: Q .l; C-e.,oc`4..c .f LL(
City: Q'ts'c:�_ State: Address: JC g-e-t 1tZ�ve,_.Q— l-'cx,)1 C tO tr_
Zip Code:`-tati Fax: City:. Pr'eccC'_ State:Fe_
Phone No.7/i.-316 '-XD' ' Zip Code:3'd(ci t Fax:
E-Mail: Phone No 77 .--32t - 75-2 C
Fill in fee simple Title Holder on next page(if different E-Mail 6!71-fist-a,1 cc Ccs G-Mca.;1.Ce.. '
from the Ownerlisted above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C0N6TRU'CTION LIEN'LAW.INFORMATION? 's: -,, :. oz°
a
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 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 FLORIDA STATE OF FLORIDA
COUNTY OF . L%c..v-lk COUNTY OF &r LU c'\--
The forgoing instrument was acknowledgegbefore me The forgoing instrument was acknowledge before me
this\'� '1
day of 'ngy , 20 i by this �
day of e.1 , 20 ,4 by
IAN t X.a v\ IS c\s°\'-st l' S\\_ik..\4 aYN tf‘‘VVe! f
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary blic-State of Florida ) (Signature of Notary Pu9'lic-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification.
Type of Identification Type of Identification �' V
Produced c"t p 1-- ,� �,�.n ra ced V- L Pt_ �r -,.;°6.4- DEANNAMARIEGNE�S
MY COMMISSION#GG 02202 i
e DEANNAMARIE GIVE, 3 2 _ mbee 16,202
Y '*_ EXPIRES. 1cUnde nen
Commission No. A5�16. , Nq1:Seal S1oN#GG0.2§m ission No. 'G�L.�S� °= (3s;e �hrutlo>a�YPubl
se-z,--r: . Y GQi�Atti I 16,'0 ?! `oe. 2�
"" - PIRES:December Public Um erwnters
FOFF
REVIEWS FRONT g{;}N1NG SUPERVISOR PLANS VEGETATION SEA TURTLE . MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
3ev. 7/2014