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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED A01 03
Date: Permit Number:
LIM_J 4i�
•
Building Permit Application
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 I/
PERMIT TYPE: wmdow
PROPOSED,INPROVEMENT.LOCATION:. .
Address: 49711 w 01
/
Property Tax ID#: J- 0� Q�((1 7/~x;250 Lot No.�
Project Name: 97// )4 w Aee eq
DETAILED-DESCRIPTION OF WORK:
e�IDve d �� a o 7Midow
S - ]' Ae
&aLrducyo S&Aers Q ) i AC e;
CONSTRUCTION INFORMATION:
Utilities: _Sewer _Septic Sq. Ft.of First Floor:
Cost of Construction:$ Total Sq. Ft of Construction:
,FLOODPLAIN DEVELOPMENT PERMITfor structures exempt from Building Code that.are.in the
floodplain:
Nonresidential°Farm Building: Temp.Bldg:/Shed used exclusively for construction
Mobile/Modular for temp. construction office: Bldg. involved in distrib. of electricity:
a fther: Floodvay?Y/N Y, fi„r.O
No,Rise Certificate with'Supporting data attached?Y/N
All other applicable state and federal permits shall be obtained"prior to commencement of
Construction.-
OWNER/LESSEE- CONTRA s
CTOR:
Name c'2 RM 1,1CName: Vetli,7 vIi
Addres : 17 P Ave Company: ur �P�'C1' d
City: ��5�°z%1f! , 0ac State:EL Address: 7f VI gf/{lY' (,j'
Zip Code: J7 Q5 Fax: City: ferce State:
e
Phone No. Zip Code: 3 qc 5 Fa/x:
E-Mail: Phone N /7 - " s7b6
Fill in fee simple Title Holder on next page(if different E-Mail YE coad X k,90VII,00A
from the Owner listed above) State or County License r202 Lf C/L
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
1
i
If value of HVAC is$7,500 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 recording our Notice of Commencement.
. UJL 12J-1-4 C&'k
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �.`� j�-V..c:C— COUNTY OF S 4
The for,going instrument was acknowledged before me The forgoing instr�ent was acknowledged before me
this day of �cn.�,�r 20'a by this�day of ac..�.,�.�` 20�` by
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_ �� Produced
U Lats� C,14z;;Z�
(Signature of No ary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. 9_0q (Seal) Commi -.7-
COTIEEN
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SUE HA ES
,uu�np, Erkifir Li,&vcc S Commission N FF 209728
"= Comnusswn FF 209728 my My Con mission Cxpnos
RE tGR�@�Tmiss a7�aQM)11j6s SUPERVISOR PLAN PFATION0f BEASTMM ANGROVE
COI %TrrEK ,i ,R$�gCt,UV REVIEW REVIE
REVIEW
DA
RECEIVED,
DATE
COMPLETED
ev. 1/9/203.9
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