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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: i Permit Number:
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
PERMITTYPE:
PRORCISED IMPROVEMENT ECUCATION:
Address: 2� �� &Ky �&- �S
Property Tax ID#: 3 7 s- /3 ^O O Lot No. C,
.i
Site Plan Name: l J Block No.
Project Name: 1 W-�(_ U-� (%Fq S 34,4 Ia'LY
DETAILED DE=�SCI�IiPTION tO ORK:
CQ STRUCTION IN'FORMA ION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric O Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First.Floor:
Cost of Construction:$ /� y Utilities: _Sewer _Septic Building Height:
N%NER AI&SWEE « INS TRACTOR:
Name S�A�P�`�k° �- e� Name: � ry )3 f
Address: 16 l/ � �'°c� Company: A/ o D
'City: .tf �==; L 1=;��� tj Stater .AdI:7J� rS'11 :�-�N,,'v<<' C xl
dress
Zip Code . ,`/ �, :7.,� ., .! FaX ;}Cify;:!�'SQL ' f ^, 'v � State: A
;Phone No t>;7�2R"3� /J _" ';?Zile, ,3 7
T.
I E-Mail Pho,te.:N0:-:x'72 _3,`?`Cj22
Fill in fee simple Title Holder on next page( if different E-Mail lD;n& CLd
`from the Owner listed above) State or County License ' �� G WI1s
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.
SUPPLEMENT CONSTRUCTION LIEN LAW INFO'RMATIO
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: Stater 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,s ming pools,fences,walls,signs,screen rooms and accessory uses to anothe non-residential use
"WARNING TO W ER: YOUR fAILURE TO RECORD A NOTICE OF COMMENC ENT Y RESULT IN YOUR PAYING
TWICE F PRO S TO YOUR PROPERTY, A NOTICE OF CO EN NT MUST BE RECORDED AND
POSTED O O E BEFORE THE FIRST INSPECTION. IF YOU E O O T N FINANCING, CONSULT
WITH Y U L O AN ATTORNEY BEFORE RECORDING YOUR N O CO ENT." .
A/Z/Y
Sign at e f ner/Lessee/Contractor as Agent for owner Signa t10F
nt cto Licen a Holder
STA E OF FLORIDA STATFLORIDA
COUNTY COUNTY
OF
The forgoing instrument was acknowledged before me
The f rgoing instrument was acknowledged before me this 3 day of 20_ by '
this day of 20ft by ' \
11 �� l�
n t-tan A Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification Type of Identification Produced
Type of Identification
Produced
(Signa ure of Notary Public- tate of Florid14
k�k 3L
(Signature of Notary Public-St to of Florida) Q Commission No. (Seal)
tip I,,I ��
Commission No. ME
_ LASHAHAIq INGRAM-RAHMING
INGRAM•RAHMING *. .*; MY COMMISSION#GG 275060
SSION#GG 275060 =,►, P`.` EXPIRES:DOWmbeilffl_M79
ES,Demodmi � Nftv�� DdE1MTitGS
Zon
REVIEWS FRON PLANS VEGETATION SEA TU VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19