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All APPLICABLE 5 INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: -(A-r` \ Permit Number:' L(�1 v 5— b .�
COUNTY' N. mi
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Fl
- Building Permit Applicat.o r togpme
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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
PERMIT TYPE: R` b c\& woes vi\-e_
PROPOSED IMPROVEMENT LOCATION:
Address: '395 5 tl�4,�ri� ,a.
Property Tax ID#: Aoff—q,L A .-'0O0( 'C00 ----1 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
7. - e ' c-o-cv uoctle c' OTCS 6.)-S`C
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical —Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric k.Plumbing _Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 7 tt Utilities:. _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Qe �` El ,Ale` C- Name: 7,m--4':e i11-,, ''�9 Erna)
- Address: SSV �'�'f`&Y k)e Company: LCORS ` 3 _ck3`cam
City "Ph: ��- AG9`7 State: Address: 17'2 S F (, 'aJne__ s-f--
Zip Code: .`x`47 Fax: City: 5C..- State:er--
Phone No. Zip Code: 5w��t- Fax: 771 1-95-cot)
E-Mail: Phone No 77 2- (16.15 ,c7'
"'tr=C� 'p`
Fill in fee simple Title Holder on next page(if different E-Mail 1ey'p On 'Ca/
from the Owner listed above) State or County License_ 1 tf4/?4 Z�7 5
,
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 Phone:
Zip: . .1
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City: ;I
Zip. Phone: Zip: -
. Phone: .
I "
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
r certify that no work or installation has commenced prior to the issuance of a permit 1
St Lucie Countymakes 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.
Thefollowing building permit applications are exempt from undergoing a full concurrency review:room additions, -
I
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential,use '; ,
"WVARNMIG TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR'IiMIiPROVEMENTS 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
H YOUR LENDER OR AN ATTORNEY BEFORE i+ECORDING YOUR NOTICE OF COMMENCEMENT'
OW 1 -
Si_- attire of Owner/ • see/Contractor as Agent for Owner nature of tractor/License Holder
STATE OF FLORIDA STATE FLOAIDAI
- t-L Ic- i
- . COUNTY OF � ' -�_-�.,.;�i� COUNTY OF � -
The fgrggOing instrument was acknowledged before me The fqrsoing instrument was acknowledged before me 1
`"l°t`d J. this dayof 9�-ecnay 20_12, by
this ay of ;�� ,20 �by: � : 1
Name of person making statement Name of person makings ement. S
OR
Type ofl y �
Personal Known Produced idenfifiication � Personally Known � OR Produced Identification ,
yp Identification Type of Identification
Produced Produced
�. d ,�
(Sign: :.of�i3tlio ss .pJpri• ) (Sig ature of N..' ':',.. - : . . - .:
Linda Carol Collins " Notary Public State of Florida
, ` MX Commission GG 309344 -°'Linda Carol Crof&
Corn • •: "Expires`-031nronn- ( ail_ - Commission No. mrttiss3cn C4t3369344
Expires 03io912fl23:
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURILE; MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW .'`
DATE
RECEIVED
DATE
COMPLETED ley.2/7/19 2/7/19
1