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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4—&�C�\ Permit Number: v`e��V�.� /c ,�/�
3"..
COUNTY ;
,F .L 0..R .1. D to
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 v/-
PERMIT
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
ENTQLOCAT�10`N..�" a i E _. : � " h ra f ., g
PRO�;OSED`I'�1/IPROVEII�1 .� �� �__���
Address: 757O 4 1.1 L. 1..,,L__ ----
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Legal Gescription:5 1) /
Property Tax ID#: '3 15 0 . I 4 - • C) f Lot No. `a_
/
Site Plan Name: /°) i<; it) 5 1 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEDIDESCRIPTION`OF -_,,..-.%z
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0144.41&L a.r ei-1 i `V o(5 & &)D Size k q-itJG-8 Iron-- tmea.c,F
CONSTRUCTION INFORMATION `' : q n�: _, o -
Additional work to beserformed under this permit—check all that apply: E
:
HVAC _ Gas Tank Gas Piping _Shutters Windows Doors
0 Electric 0 Plumbing Sprinklers E Generator LJ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ cc 6 -q, Utilities: _Sewer__Septic Building Height:
OWN ER/LESSEE; . ... rS: =y ', °fF tCOrNTRACTOR '`ti xf .M�, r, T
,..�' ,,,,-.tii '4.r,•...,�„.`f v . ?!.i {c n VM'Fi.,-z-"gym- .i.2 ,!f . ... ' ,._ . ,?.3 si x n:rcE.`*�.--,, A*.
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Name_,,V—be4-,n.2 ili aK'N1U e Name:':K':,r•r3�`� `t :: q:ic,t s-Cc'Y
Address: C,, 11a ��o Company: 1'1-(;-) C� -p.e kr ;v Q_
City: Po ri- St' Li) V1 State:FL, Address: A:2)- is l —7jTi-i 0.--r- Ar)
Zip Code: .3ifq V-)— Fax: City: I-C.k sflm 1vrv� j C-LO Ls— State: 1-=(---
Phone No. 77a. 3(iv, 2 5-13 Zip Code:..3 LII a- Fax: 5 4,i . --3"-".:5-5"--'IOS L/
E-Mail: Phone No. 511/- S-- '(C'S
Fill in fee simple Title Holder on next page(if different E-Mail: re,becc o.• P rrr1+ 4.9roupFG.coM
from the Owner listed above) State or County License: 0 63 0 0 :::,=1 D—` 31.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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z" Sl1P ill1 arikeral RU, ild iltk LAW 4J' FO•RMATION , ti, �C4t 1 s;; �k�
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DESIGNER/ENGINEER: I _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:
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 your Notice of Commencement.
•
ACirvi i? /I ////i/ Zk:;:26).---, � s
_ "gnature of Owner/Lessee/Agent ure ntractor/License Holder
STATE OF FLORIDA - 7r`o STATE OF FLO IDfi
COUNTY OF _ COUNTY OF .Gi iv, /3&_-_,6-6
The oinginstru jet w Qknowled a ore me The for Ding instru ent was acknowledged efore me
this i day of // IiJCf(C.v , 20 I y this I day of peI`( ( ,20 /� by
do ( niCK-OPCky?�� es D- )n
(Name of erson a •n••%ledgin'g (Name of person acknowledging
f
(Signature of Notary Public-State of Florida)A• //- ( & (Signature otary Pu ic-State of lorida)
Personally Known OR Prodp,..,decilifiptiop C Personally Known r�R Produced Identification
Type of Identification Produced • �� Li €�pe of Identification Produced
OiP�YP4BI� AN .AYOUNG
Commission No. =°"a�`°e,- P( �j "1,McHALE Commission No. __ ���
* _�,_ * MY SIGN#FF 951069
o MY COMMISSION#GG168796 a, -'9I!=-=`oma EXPIRES:April 12.2020
" _ EXPIRES'December 17 7071
-9". 4,z)
F' bonded.=_. ayeinorarysernces
Revised 07/15/2014
' REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER • REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW .
DATE
COMPLETE
INITIALS
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