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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED JJ
Date: �-�1?�� Permit Number:
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s
- - - Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (7.72)462-1553 Fax: (772)462-1578 Commercial Residential_
PERMIT,TYPE: /
ROOM—
,Address:
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PsRO?OED`INPRO. �EMENTOCATION
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Address: ., ✓'"� ��C�� L-ICI -
Property Tax ID#: Lot No.
Project Name:
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I)E7AILED DESCRIPTIO1 ORK ta�� �� > �5
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Utilities: _Sewer, _Septic Sq. Ft.of First Floor:
Cost of Construction:$ 0C-D Total Sq. Ft of Construction:
' ®0�DPLAIN DEVELOP.. NT PERMIT r stru ores exemp,. ,r-.o Building Code hat. ream the h
„fin esidential Farm B "ilding� ,�p lempq Bldg./ hed a; a eclsiveL afar con`struction � 7
Mobile/Modal r f..o:r tem construction office Bldg. involved In distrlb�of eleCtriclty� 4
- Other: FIZone: BFE3. Floodway?Y�/N ,tf Y,T ,
N `R a Certiflcate'wlthsupporting data attached?Y/
I All other ap:�;Ica.Le state andfedera_�,perm;it .�ha11 be obtained prig t� comme cern`ent o,;� .:
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eco cion.
DOWNER/LESSEE �� 000
MGONTRAOR•
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Nam���d�G USS Name:Jl��✓1 S
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Address: Company: 61C-rC1__Ae_��� SQr0, (JL
State: I Address:e_"�7JC17_c_.) Y-)f. CX:� 1L.t-S
Zip Codes:" - ISZ Fax: City: - � lc_ Stater
Phone No. �� '� �� Zip Code: Fax:
E-Mail: Phone No
T1' ISL
Fill in fee simple Title Holder on next page(if different E-Mail t�f CL0.,5,61 U10L 031 Y✓lC«I (A)
from the Owner listed above) State or my License 3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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If value of HVAC is$'7,500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTG COMPANY: _Not Applicable
Name: Na
Address: ddress:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: of 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.
Signature of Owner./Lessee Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ` is &t' COUNTY OF S� • ��
The forg ing instru ent was acknowledged before me The for oing instrument was acknowledged before me
this day of yN QV)UV_LN 20by this day of NC4N-AN ,20 1 C1by
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
Prod ced Ulfl Produced �, 1pt-
AMEGONZALEZ °P GO 2
ti �:
(Signature of lqotaryPu liC' , o G 181686 (Si natur of Not P b c6• f Florid i cion 3GG tet 86
�7 p ,` My Comm;Expires Feb 1,2022 g ry '.'o, `oF: My Comm Expires Feb 1,2022
Commission No. C�' thro 9131 ionalNotaryAssn. Commission No.c'q' 0throw �' nal Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.