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kL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
• Date: Permit Number: q()(0 C& �oL
RECEIVED
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Building Permit Application JUN I 2018
Planning and Development Services Permitting Co M 4
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
RROPOS.EDT:IVIFROVEIVIENT;LOCATl'ON: .
Address:
Legal Description:( :ir)14- Ll'1l, V, 110 1-1 n lT
Property Tax ID#: � - tQ V ' �°�I�' 111� Lqt No.
,Site Plan Name: _ `, Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D-ETMLED,
-D;ESCRI'PTION,OF WORK "
CO,NSTRUCTLON I-NFORMATION
Additional work to MGasTank
r orme un ert is permit—c ec a tat appy:HVAC []Gas Piping �_Shutters a Windows/Doors
Electric ElPlumbing Sprinklers Generator F] Roof Roof pitch
Total Sq.Ft of Construction: S . Ft.of First Floor:
Cost of Construction: $ ` ®, '� Utilities:cn Sewer E]Septic Building Height:
O'WkVLESSEE:. CONTRACTOR:
Name Name:
Address:51 3 h�.jr Company: l h_ WC,
City: + cState:�1 . Address: /0577 ( �rnmyz 1 ai �
Zip.Code:' Fax: City: State.
Phone No. bC' O—- 5 l - S5-14-- Zip Code: (32q? Fax: 34
E-Mail: +1A G-. Phone No. (,:� 152-9-
Fill
Fill in fee simple Title Holder on next page(if different E-Mail:dot11 a� t C.C�
from the Owner listed above) State or County License: 'QP, 06 42
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
t.
�S PPCEMENTA, 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:
1 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 our Notice of Commencement.
s
Signature of Owner/Lessee/Contractofts Agent for Owner Signature of Contractor/License Holder
STATE OF FLO IDA STATE OF FLO IDA
COUNTY OF �1C(� �� C COUNTY OF (&-n ty��
The forgoing instr ment was acknowledged before me The for ing instru ent was acknowledged before me
this-nay ofn n 20 �y this day of 20 by
(Name of person acknowledging) (Name of person acknowledging
( ignature of Notary Publ' tate of Florida) (Signature of Notary Public-State 6rFlorida)
Personally Known d-� OR Produced Identification Personally Known i� OR Produced Identification
Type of Identification Produced Type of Identification
�Produced
Commission No.% 21 (Seal) Commission No. C-ti5 12 (Seal)
LETICIATREJO
Revised 07/15/2014 ti,�� , Notary Public-state of Florida ;,.s ,;'P�•.
LETICIA:GG
0
:, .•@ Commission#GG 103721 r°w�:�': Notary Public-state of Florida
rt: _ + • •= fission N 103121
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COUNTER REVIEW REVIEW REVIEW RE —RE-VTEW REVIEW
DATE
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