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All APPLICABLE INFO MUSTgBE COMPLETED FOR APPLICATION TO BE ACCEPTED �j y�^
Date: 5-5- C l Permit Number: I- 1 0£-CJo8"I"
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.. -- Building Permit Application qYo
Planning and Development Services es,,tio ?819
Building and Code Regulation Division ��ce Faa
2300 Virginia Avenue,Fort Pierce FL 34982 Pa
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED INPROVEM ENT'LOCATION ,
Address: 1%3 15 PCS rkiCLUO
Property Tax ID#: 3 Lf 0 9-r7ti. - o /a--/- 000/.4- Lot No.
Site Plan Name: - Block No.
Project Name:
DETAILED DESCRIPTION OF.WOR(
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.I )6--Fee I- wocx,S m fi nc.9„ , 61-1-66- -b t I. -gc,k -c3
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CONSTRUCTION INFORMATION :' ;.
Additional work to be performed under this permit-check all that apply:
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Mechanical Gas Tank Gas Piping Shutters Windows Doors
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—Electric _Plumbing _Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
1
Cost of Construction: $ 03-- Utilities: _Sewer _Septic . Building Height:
OWNER/LESSEE. `, CONTRACTOR
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Name 0,}�, Or .cry-e,� Name:
Address: 3 cb,\NitiArj (\yrs Company:
Citfk- lftei al- Statef�- Address:..
Zip Code: {%(-)NFax: City: State:
Phone No‘.-1-1 - —i 15�- 9-';-1k. .. Zip Code: . . . .... Fax:
E-Mail 0Y3VckCAL.--4)-9 u 6 0 (PVl .cQM, Phone_No
Fill in fee simple Title Holder on next page(if different E-Mail 1I
from the Owner listed above) State or County License 1
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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 LAM/INFORMATION: s
�x.
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 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.
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Signature o wner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAIr , I STATE OF FLORIDA
COUNTY OF ,_2\1 ( LA (L L COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 2____ ,20_ by this day of ,20 by
I . al —
Name of person m 1!ing s ate ent. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification n Type of Identification
Produced D( Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (k1)EN VAUGf. Commission No. (Seal)
gr,:EConiissionlGG27oot
_State ofFlorida-NotaryPuc .� .
. iwy Co mission Expires
REVIEWS FRON --;zs ".L �' PLANS ..._ VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW` .. REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
rev. 9/26/18