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ALL APPLICABLE� la
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: V 011 t Permit Number: 1 SifD ,J
Ca u IV T Y _ RECEIVED
F R ID ,
Building Permit Application OCT�o
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Planning and Development Services per 1418
mittin
Building and Code Regulation Division St. Luc oepart
2300 Virginia Avenue,Fort Pierce FL 34982 a co n t
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Legal Description: ('a.3 5 3-7 S 7I Y t c 6:-
Property Tax ID#: as I dt-o'tLL I ` O00 I -OC)i` s Lot No.
Site Plan Name: Block No.
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Project Name:LJJ fCL 4( fr\e,,5 C S
Setbacks Front Back: Right Side: Left Side:
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Additional work to be�erformed under this permit-check all apply:
HVAC _Gas Tank [JGas Piping —Shutters a Windows/Ds
[Electric Plumbing Sprinklers �Generator �I Roof r,
Total Sq. Ft of Construction: S . Ft.
of First Floor:
Cost of Construction:$ (i)3 $5 I Utilities: (Sewer El Septic Building Height:
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Name W e_nei.y JY ante-r 3 Name:".JakrvIrS�Tae t.rt,r-. - q,;ca.',ss(t—
Address: 1Ca\,C'iO OC��2..G<ue. Company:'-----5 -(c c r9€ �
City: �O c�' P►-GrC.0 State: 1'( Address: i Lt iQ t '?j-PH CI-1-- A-).
Zip Code:34 Q Li 5 Fax: City: 1 0 k 'ft-,k wi E-c-,C•4 State: 1--'-L---
PhoneNo. Zip Code: -IID-- Fax: 51.4_•i -. S53 4/059
E-Mail: Phone No. 5-1#1- S.-.5`.a - 41 05-a.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: L (ED0 0 - 31
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: 1
City: State: City: State: I
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name: j
Address: Address: I
City: City: :I
Zip: Phone: Zip: Phone: I
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I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Countymakes 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 I
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice ford
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.
1
lM ,r 4/I I ic..D �).--- 0„ - S
_Signature of 0 ner/Lessee/Agent nature bfContractor i
w cense Holder
STATE OF FLORIDA STATE OF FLODA
COUNTY OF 34-•J_1 GI -Q.• COUNTY OF O f1/Vs SenCt)
The for ing instr ent'was acknowledgedMore me The forgoing instrument was acknowledged efore me
this / day of :�-' , 20 iG by thisaGday of _s'e901—, ,20 k- by
• ,fie t 45+erS ja. e.S P., ���,
(Name of person cknowledging) (Name of person acknowledging)
I p
(Signature o'J otary Public-State of Florida) (Signet a of Nota Public-St of Florida)
Personally Known OR Pro�ced Identification V Personally Known 17 OR Produced Identification I
Type of Identification Produced % n/_ Type of Identification Produced
osARY pt,e, ANGELAYOUNG
FY • , of .i` GIiNIAR P 1 S7- R Commission No. >„ * MYCC(:::taPN#FF951069
Commission No :IVO'''4= EXPIRES:ApAL12.2420
-+°'a '"" MY COMMISSION#FF912939
in �..1F' :IVO'
�oQ� BoMed'Nu Budget Notary BeMaes
.V7)398-0153. FbridallocarySenrice.con:, • 1
Revised 07/15/2014 I
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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