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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i
Date: Permit Number:
0) - Diq K
RECEIVE®
ry'' JUN �� 1018
COUNTY.
4.. . O'• R 1. .D."", ,.
_ _ mlttinitting pa
Building Permit Application Persle tyent
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: '9-d`(.) ) l r‘err ')Q.
Legal Description: 21L114-7" Par t / j - 9`k' 7
Property Tax ID#: '3 U(q-5-al of 0.57-00-c)-9 Lot No. 17
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION,OF WORK:
/ cp..4 VGI✓' 0-0 War it)i to
CONSTRUCTION INFORMATION:
Additional work to bps4rformed under this permit—check all apply:
HVAC I 1 Gas Tank ❑Gas Piping Shutters Q Windows/Doors
['Electric 0 Plumbing LI Sprinklers LI Generator I I Roof Roof pitch
Total Sq.Ft of Construction: S94 of First Floor:
Cost of Construction:$ .5675 Utilities: Sewer El Septic Building Height: _
OWNER/LESSEE: CONTRACTOR:
Name 5€04e 5 )G.lielet 11)1 4(1)7/1 Name:
Address: k 51(/ fit. cX 1/j Company:Cazi ‘20-0-''
City: & 5t 1 et Q State: / Address: 601 .5(4) i/f 1&kr Irlc -A
Zip Code:741116 Fax: ,//' City:P'e'r, Cr/cid' State:1`/
Phone No. 77P-r(9- .9-707 Zip Code:3 495'3 Fax: //1
E-Mail: /l/4 Phone No. 72(9-WP- 7e-r2-7
Fill in fee simple Title Holder on next page(if different E-Mail: a C�e46/5'OW,
te/
from the Owner listed above) State or County License: . / o�3 8'
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. -
•
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 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 recordi g your Notice of Commencement.
aer77
411
Signature of Owner/L'em f Contractor as Agent for Owner Signature of Co ra'o icense Holder
STATE OF FLORIDAII .. .. w, - - STATE OF FLORIDA
COUNTY OF SA-. lJi/`�.L�� COUNTY OF
The forgoing instrument was acknowledgbefore me The forgoing instrument was acknowledged before me
this 1( day of 31�vim_ ,20 16 by this day of ,20 by
g.vA/1
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
Produced I Produced
1
kAlt\av it
(Sign- +re df Notary Public-State Oil Florida) (Signature of Notary Public-State of Florida)
Commission No. • (Seal) Commission No. (Seal)
P�a�,, LASHAHNA INGRAulM
�� c Nnta
� C:ot� Ficrum
C' ;� , n
My Cornm. '01:Eo` ,
REVIEWS FRON qrF a iNG ConviiS�1�P }%PSO ' - t NS VEGETATION SEA TURTLE MANGROVE
COUNTER,",°A `f VIEWidedtt-ougR VIE , `9 RES/IEW REVIEW REVIEW REVIEW
DATE Y-
RECEIVED
DATE
COMPLETED
Rev.8/2/17