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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Au>-04(z-
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Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue,Fort Pierce FL 34982 CO
Phone: (772)462-1553 Fax: (772)462-1578 CommerclaResidential
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 1070 q 41 S CJ(,cFAIJ X72 • ao I
Property Tax ID#: 4[SoA Po 14 Odes 0900 L4 Lot No.
!Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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.CONSTRUCTION INFORMATION:
Addition work to be performed under this permit–check all that apply: —
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echanical Gas Tank Gas Piping Shutters Windows/Doors
Electric Plumbing `;—Sprinklers Generator Roof Pitch
!Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 512 Q Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: ` ' CONTRACTOR:
Name Name: C3. at/<vzr
Address: `b o q z( 5 �r ha AA�,�1 Company: `Lj)2-gms-,
JLf AIC. 1N<
City: State: Address: G33 NE 14ylu w L.+�
Zip Code:, I q Q L<!J Fax: y/ City:09,-r ST Lyu L state:L
Phone No. qly Zip Code: YJ 4 PQ Fax: >c
E-Mail: Qggd _% M---rM L2 Q?7' DA&1,V .N ,Phone No
Fill in feesimple Title Holder on next page(if different E-Mail &✓AICA RT Ziu 1,3 ( G Alt • CJM
from the Owner listed above) State or County License (!A Co I Q_6_
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU TICE OF COMMENCEMENT:'
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Sign e ol Owner/Lessee/Contractor as Agent for Owner Signature ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF V4 3,COUNTY OF1.�,0 1-0
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ,20_ by this day of ,20_ by
Name of person making statement. Name of person making stat ment.
Personally Known OR Produced Identification al Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature of Notary Public-StA of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No.
LASHAMINGfiAM-RAHMING :•�,n'r,>:"• LASHNiP1AINGRAM•RAHMING
REVIEWS FRO ;; *-NOWN ES. I Q/� PLANS VEGETA *� ,o A
COON EPEE ,° E ilru REVIEW REVIE �'••FaF•,
DATE
! RECEIVED
DATE
COMPLETED
Rev. 1
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