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All APPLICABLE INI FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED + C�
Date: '' ir'q Permit Number: ` `c� 0,4-3
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Rec..
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F L O R I a — <_- erm�tt. 418
mossimmossommommoi- _, Building Permit Application<U eoepdrt
Planning and Development Services �0u"ty e"t
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: i2.- - � --- UYlo cam_
PRO D n@atiMPR@VOMMT LOCATIONq . 'a sa
Address: S'Z I S I'- -oLTi �vt, c4 c IBJ ,. -rt, 34' S2-
if
Legal Description: SA'va - _ s , r _, - L L t
Property Tax ID#: 34-2_51701 ( ' ems- Z Lot No.
e.. --5 Site Plan Name: eMer-,---t.....)Ge Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
AILED=I E-CRIPTIO OF WORK: . 4.. ° a
"I'd (Zc,Ni „c.,14-11--s 6t_.c-5 (� ,41,-1 c_ {�e- S L.14._ tz,,3�wL, \"..s
a&i V 1 6.-)cc' _ Ai elk.) v�L{-W CMZ.-5 of s Zl t."-z- Pti.Gtt
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.CO`'S RUCTIO PORMATIO b. $ 1. M ,. - ,. A 'R.
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters __Windows/Doors
Electric —Plumbing _Sprinklers _Generator ><Roof 21 t-2. ' Pitch
Total Sq. Ft of Construction:, f(DOC, Sq. Ft. of First Floor: -
Cost of $Construction:
�nDO‘ Utilities: Sewer _Septic Building Height: 1 5 1-znt...1
OWNER/LE}SSEE? '.: ' a.w. . : M. aCO.Nl RAC 11'I,O,R:
Name .C�lts..) i3,a,l:.tpL. -1 Name: (A 10 5cu�ty
Address: crz t 5 I, env t c c tic 6t W Company:C D = t�-s 1..LC_
City: p 5 t_ —r State: f L Address: 32?,L' 0 ucl .‘U
Zip Code: 314.1S"2-• Fax: City: tic P@vti€` State:'
Phone No. 57o 5'7 5' 5. 1'i 3 Zip Code: 349.r7- Fax: V2— �1 -C.0 s—
E-Mail: I Phone No `2 7Z 2-t —8-61-r7
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License (IZCS 5-13 /l 2$"1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S. PPLEM co®N5TR+CJC B®N LIEN LAINANEOR, ATI@N ; a,• . , : z, &'
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 • -r paying twice for
improvements to y.. p opert A Notice of Commencement must be recorded , • po• ed on the jobsite
before the first i pect'. "you ntend to obtain financing, consult with I= -r or a• - or -y before
commencing j ' rk or - ordin:, 'our Notice of Commencement.
4/1
`L _ _A L/_ lam-
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Signature of Owner/ Contrlw Agent for Owner Signa ure o Contractor/License Holder .
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Si— ( uv_u_e; COUNTY OF FLORIDA,
��c.I
The forgoing instrument was ac nowledged before me The for oing instru e t was acknowledged�efore me
this )) day of Bvv ,20 1gby this if/ day of , 20 I by
SY‘ - (A5 Th lJal7 /VCJ CS U c—
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification/'J Type of Identification
Produced I v f/ C/ Produced
)(i`a,( p))0,14---------------
(Signature of Notary Public , (Signature of Notary,E ')jc, StateadflEEf lii UGHN
.�,' I',,,, ELLEN VAUGHN �°` . e� State of Florida-Notary-Public
.� 4 . ��#= Commission GG 70079
Commission No. 'i *istexs ilpooriR p.Nottory Public Commission No. Sly'''.Y4 My Commis Ixpires
1.,,,.;----i,_ ,_akI GO '� ` October 22, 2022
_My comrniosion Expires 1
I"' 0 t,bar 22, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED ,
DATE
COMPLETED
rev. 8/2/17