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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l/��,(� ( ,1/�
Date: 5-1-\.0 Permit Number: 1 I v���W''\o'`'
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COUNT - RECEIVED
F L O R I A
14.1111.11111 Building Permit Application MAY 011 2019 ,
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St.Luce County
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE:
PRO:0- 'o'IMPR®Vata" fl }® '\`ifikRi .i:::-.%, , :" '1r.,.t: . i W _ _•,. _
Address: 5 70- I_hi :C14K Pi c -. Pi cic:_e_-.e-i.___ -3i-i c tai a-
Property Tax lD#:3`i1C)- S D3-0135--0 )O "b Lot No. 9-t{
Site Plan Name: Block No. A-
Project Name:
ao r-RP9 c3 DI=sC°IP l o 4 0 vvd,°,M _
kz-r�L S- Sl- � tz. vi ., . psi .S cC . ._U4:1,11-161A(
IRam . IN'-ORWA ll[I , ,,,;:,,.`:1,,.., , i ' 3 .,=
Additional work to be performed under this permit-check all that apply: .
_Mechanical _Gas Tank _Gas Piping —Shutters —Windows/Doors`�
_Electric _Plumbing _Sprinklers _Generator 7 Roof ",1\ Pitch
Total Sq.Ft of Construction: 21 L'- Sq.Ft.of First Floor:
Cost of Construction:$ S 15'3 v Utilities: _Sewer Septic Building Height:
1 ,0 'UER/LESSEES - CON ,o AC ®R ��. . :'
Name /I2 c . SClc-t-•.e--Z- Name:Kr:Aq AA_ Li) ',Vc..
Address:S-7 I a. c H1.^c c P( Company:St- r d ne RE-,F-vv-
City: Fiat P'five_ Stater Address:1 i 7 3 Ski V-1 cr,,I c 1-e-j•fi`J
Zip Code:3`f 5 �-- Fax: City: co(.r SC:nk I-4( State:FL_
Phone No. Zip Code: 3,15?•7 Fax:
E-Mail: Phone No T)}--a6 0 - 1-565-
Fill in fee simple Title Holder on next page(if different E-Mail 5i1 (-c-1;s'C--iCI r,-Pt'n j f _Q i-,b 6 . <a m. ,
from the Owner listed above) State or County License CL-C 13�1 j b
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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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,Ido 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 I
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF U INTEND TO OBTAIN FINANCING, CONSULT
WI, H OUR LENDER OR AN ATTORNEY BEFORE RECORDING YQ NO ICE OF COMMENCEMENT."
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Si ature of Owner/Lessee/Con ractor as Agent for Owner Si ature of Contractor/License Hold:•
STATE OF FLORID STATE OF FLORIDA
COUNTY OF Q COUNTY OF `10 last R..)
The for Ing ins ent w s acknowledg before me The • ;•i g ins t Rent wa acknowledge before me
thi ay of ,20 I1 by this_ I •say of lk'f 1(l Jl l ,20)� by
dared U 3lPdinct
LOLiuL
Name of person makin statemen Name of person makin statement.\s,
PersonallyKnown I OR Produced identification PersonallyKnown v OR Produced Identification
Type of identification Type of Identification
Produced Produced
Lbw!
Mout_ LbAcri n(h3U—
(Signature of N t ry Public-State of Florida) 1Signature of No Public-State of Florida)
0,IIY Pbgt BRANDY MOORS or Puae BRANDY MOO 1E
Commission No Ioza3�. f�„ w Commission#GGk:ommission No.a7Iv283 ,''� 1?al)Commission#GG^0;)39
i* i, ••,r Expires May 9 2021 N %m.,.
a<_ HondeA Thm Budget No ery Sorvtcos r �, Expires May 9,202°,
��OF P�0mfr Op ft.u- Bonaea r nru Suva Noieiy S vices
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE ,
COMPLETED
ley.2/7/19
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