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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i• cx • I l /�Permit Number: ` v` 0 ) J -0,/.1 0
_____ . RECEIVED
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COJT
F L Co R ! o �= JAN 2 5 2019
:_ � Building Permit Application
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County,;FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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PROPOSED INiiROVEMENT LCAT ONo' . :yin°
Address: q7 60 S V(ea-. r l'e-iik&t) 8C A-04r Fe-- ,/PI-, )
Legal Description:
Property Tax ID#: 1 S oa -10-as - b (S( a-- 6 sz 0 -0 Lot No.
Site Plan Name: Block No.
Project Name: I
Setbacks Front Back: Right Side: Left Side:
MICA LED 1)&86RIflI1.20EWORK°
A/ei-' 7-79/1/14LE5.5 /// 0 I ed9--7 e4._.
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CONSTR CTICON 1NFORMAT ®Ng ° -
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas.Tank _Gas Piping _Shutters —Windows/Doors
Electric alumbing _Sprinklers _Generator- _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
0
Cost of Construction: $ ( 2--02 •19Utilities: _Sewer _Septic Building Height:
® NE' ,... E ° a ° • ° GONiTiRAallilliiMillinn
Name &IQ() ( ,� [It�ti, Nam uiPi-a 11°&i
Addrss: _. - com`an
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q
City:J f?Aj5Ehf ,8Exteq State: fZp- Address: J2,7/ l /51/4--e 4-0.0d ki ,i,*4
Zip Code: Fax: City:,1)4,Vt - ..g -i9ef(, State:1 ..
Phone No5/4 ' 9'7z- g-6.zo Zip Code: ,S7.3J12.. Fax:
E-Mail: C-i74///1 7(jobt/7 , eo✓'-- Phone No fgy.° 3z . 3,3 0
flu iv►�,
Fill in fee simple Title Holder on next page (if different E-Mail �t CP e �l�?� � ^� . L(�Ph.
from the Owner listed above) State or County License -fe 1127 8'(g
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. A 9 71 N,
SUPPLEMENTAL CaNSr RUCTICMI LI 4e1 LAW I .. URMATIOIVa
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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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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 your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA ) STATE OF FLORIDA S 1
COUNTY OF S t Litc • COUNTY OF ?
� �.t
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1 L day of _ koN1 ,20 f2 by this (to day of NOV , 20 LK 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
bekLe_4, - ('.k.eL
" Y p''''• MICHELLE A.KUCHAR I ;.4�n"�''%s•., MICHELLE A.KUCHAR
0 4'. ilotar Public State of Florida `
(Signature of Notary P• �a i�titY�ly�r�1StateotFlonda I (Signature of NotaryPu f' �" hof Res-ltd.:54m qGG 245232
•I nte CommissrodM GG 245232 .,�.• yo-;
'•�'oFr�°; My Comm.Expires Oct 5,2019 I My Comm.Expires Oct 5 ,2019
Commission No. ( Bonded through(NMa)al Notary Assn. I Commission No. Bondcr�Uuougi I Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
iev. 8/2/17