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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��' Permit Number: ®(62` 0015
RECEIVED
JUN 05 2019
- Building Permit Application
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 34982 v/
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
f fi :ix ,i t ;" il qui`: "•N" - },a'
PROPOSED IMR;ROVEM`ENT=LOC'ATION;
Address: 51 AQ 2 V ee
Property Tax ID#: V Lot No.
Site Plan Name: Block No.
Project Name:
r
DETAILED DESCRIPTION OFWORK x�•' = ` s
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
011VNE'R%LESSE'E ONTRfACTOR
Name 1( Ka m e: 44ig_ /4.S rAIA1654
Address: 510 10 C4 Y-f V L Company:
City: f (57- �( �— State: Address:
Zip Code: 1401 Fax: City: State:
Phone No. If!g 5� ' 3�0� Zip Code: Fax:
��
E-Mail: Sq(-6) q'���-2-')E�� -CWYN Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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.
SUpPLE-MENT4 CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not ApplicableMORTGAGE COMPANY: _Not Applicable
Name: SEe5 1��69ce5b 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOt4R LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Own('Yrttessc
ontr ct r as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA r STATE OF FLORIDA
COUNTY OF UJ COUNTY OF
The forgoing instr ment was acknowledge before me The forgoing instrument was acknowledged before me
this day of 20_q by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identi ' ion Type of Identification
Produced P L 1 L Produced
(Signat re of Notary P (Signature of Notary Public-State of Florida )
�tipnrv�e, KAREN S. NIELSEN
State otSF� da-Notary Public Commission No. (Seal)
Commission No. Com lssion #GG 207484
"Y"
My Commission Expires
annJune)
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