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AIIAPPU BLE INFO MUSrBEOCNIPLE PDRAPPLJWONTOBEAOCff'iID 1
Date: I Permit Number: 1 c
W ' '�� RECEIVED
o _
Building Permit Application OCT 2 4 2018
Planning and Development Services
Building and Gbde Regulation Division ST. Lucie County, P rmitting
2300 Virginia Avenue,Fort Pierce R-34982
Phone:(772)462-1553 Fax:(772)462-1578 Cbmmerdal Peddential
PERMITAPPUCAMONFOR To Select from dropbox, click arrow at the end of line
PRORM IM PFiIOVBVI BVf 110N.
Address 20 1
Legal Description: ; ,��� GL —1,1nW 5 1
L �,Zo �9)
Property Tax I D#: yD — O ^�� Q— Lot No.Q u 10
Ste Plan Name: Block No. a
Project Name:
Setbacks Front Back: Rght Sde: Left Sde:
DE-AI' D89-PTIC I DFW-OF
Azle
.mss
I4 ® Rem yug s
CCmrFum INFmF Ancil
Additional worK TO D orm un erffc.
ermi — •appy:
HVAC Gask asRping _Shutters ❑Windows(Doors
❑Bectric ❑Plumbing ❑ orinklers ❑Generator ❑Fbof Roof pitch
Total Sa.R of Construction: SoLR.of First Floor:
Cost of Cbnstruction:$ o, 60 Utilities USewer❑Septic Building Height:
OWNBTIName i n Name: h a ZG(iY?i 7
Address: 7195E Company: _A41 ex"4-i C 0-73r-- jr ,c
Oty: Pj R,YC.-e_ Sate:_ Address: 1467 S COV- 0c".0t
Zp Cbde: "a r,9, Fax: Oty: UY�- ate- Sate: -F-Ll—
Phone
Ll—Phone No. 770 — 9A 9— /7 a 7p Cbde: v�L�� Fax: IV14
E-Mail: /IZI—A Phone No.
RII in fee simple Title Holder on next page(if different E-Mail: ' D GGi% 6,001
fromtheOfunerlisted above) Sate or ntyLicense: 4
If value of construction is$2500 or more,a Rte®Notice of Commencement is required.
SUPPL81 ENTALOONSTR ETION UEN LAW INFOR WICIV:
DESIGNER ENC31NER Not Applicable MORTGAGEOOMPANY: _Not Applicable
Name: Name:
Address: Address:
Qty: State: Clty: State:
7p: Phone Zip: Phone:
FEESIMPLETITI_EHOLDER _Not Applicable BONDING OOMPANY: Not Applicable
Name: Name:
Address: Address:
Qty: Oty:
Zip: Phone: 2p: Phone:
OWNER OONTRAGTORAFRMAT Application is hereby made to obtain apermit to do the work and installation as indicated.
I certifythat no work or installation has commenced prior to the issuance of a permit.
whi his inou t is wit nano re resent ion that isgrant�'nq apermit ill thorizethe rmit holde to build the sub'ect str.cure
�o t eii any rave Home is ON resas�o�ation ru�e� yaws�r anoov y antsth�t may react�r pplohi�it such
strutxure. ease consult with our me Owners cation and rewew our eed or an restru�ionswhi ma apY.
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 Rorida Building Codes and R.Lucie County Amendments.
The following building permit applicat ions are exempt from undergoing afull concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory usesto another non-residential use
WARNINGTO OWNER Your failure to Record a Notice of Commencement may result in your payintwice for
improvementsto your property.A Notice of Oommenoement must be recorded and posted onghe jobsite
before a first inspection. If you intend to obtain financing,con with lender or an attorney before
coni en 'n ork or reoording your Notice of Commencemer} .
( jr� Lit--(
9 ure of Owner/Le ractor asAgent for Owner ;KOFR-ORDA
f Qmtractor/Licen er
STATE OF FLOPo OOUNTYOF OF
The bng instr as acknowlecl before me The bng instr nt�acknowlecl efore me
thi day of 20 by thisday of 20 by
V
Name of person m g btX'&rrehtl,1 0 Name of person making statement /
Personally Known OR Produced Identificatio Personally Known OR Produced Identification
Type of Identi'cation Type of Identificati
Produced Produced
(9gnature of Notar Pubiio-Rate of Florida) (9gnature of Notary Pu bo- ate of Rorida)
Commission No KA R E") N I E L S E N Commission No.
tate of Florida-Notary Public ,�t►� pg',', ARE IELSEN
=* •� Commission #GG 207484 =� o',State of Florida-Notary Public
•c Commission Expires
June 12, 2022 '%�` ppyO`� y CT oMmi io EOgxpires
REVIEWStE
OOUNTEft REVIEW REVILN FEVIEW
DATE
FEMVED
DATE
OOM RETED
Rev.8/2/17