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ALL APPLICABLE INFO MUS BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: Permit Number:
RECEIVED
Building Permit Application OCT 2 5 201$
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Pefnmitting
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 LOCATI : N _ -
Address:
Legal Description: L
(-3,
Property Tax'ID#: 3 Q'13n 31 l 0 CD 000 �s Lot No.
Site Plan Name: ?�lazt J & �� Block No.
Project Name: �jll_ n
Setbacks Front Back: Right Side: Left Side:
Ail
DETAILED DESCRRPI"ION OF WORK ' s 3 M4
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CONSTRUCTfON INFORMATION
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1tional work to be performed un ert islpermit—check all nappy:
OHVACi Gas Tank ❑Gas Piping _Shutters O Windows/Doors
FlElectric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: s; Sq. Ft. of First Floor:
Cost of Construction:$l�oj� Utilities: Sewer Septic Building Height:
OWNER%LESSEE ` 90'NTRACTOW� `F '
_ u �.
Name a, Name:
Address: Company: 2 c
City:�; Lc o State: �� Address: /y`q � :2�k _ f<
Zip Code- 446 CQ Fax: City: State:,
Phone No. 3C� �9, r' Zip Code:3 L4 ra0 Fax:
E-Mail . _ fin�ri�l-►�L4,0_cVW_QLp.. Phone No.
Fill in fee simple Title Holder on next page(if different E-MailqleX-f� "P-42esa"A'C'
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LILN,tL-A'VI/ IN ®R ' °ATI®N-
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: i Phone Zip: Phone:
i
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.
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
commencin work or recording our Notice of Commencement.
i
ignature of O n r/LesekeXontriaftor as Agent for Owner ign ure ontr for/License older
STATE OF FLORI STATE OF FLO
COUNTY OF COUNTY OFc a Pim
The forgoing instrument was acknowledged efore me The forgoing instr dent as acknowledged before me
this�day of `�-� 20Z by this day of,= 20j_J by
i
Name of person makin t ement Name of person making at&ent
Personal ly'Known 2'OR Produced Identification Personally Known>_OR Produced Identification
Type of Identification Type of Identification
Produced Produced
rti
(Sign ure'of Notary Puic- a tifjFll�atdey)Public,State of Flori (Si ature of Notary Pub' Floridat $SICA PRE$COti'
1 :�f MY Comm.Expires Oct 1,20 *' L Notary Public,State of Florid
Commission No. gv'.....: j
;°' C&Ai6ion No.FF 923361 Commission No. 4. oma! My Comal)Expires Oct 1,201
o..... .f Commission No.FF 923361
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17