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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ,
RECEIVED
° JUN .12 2019
Building Permit Application
permitting Department
Planning and Development Services st.Lucie county
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:~
Address: 21 k9 /y 6y C�I� J C�2t A dL L N p�11.W� e lT`/ FC. 3 q`?,7 0 - ---- -----
Property Tax ID#: q q Z� _BoS - wU� -obC)r Lot No.
Site Plan Name: I-IA10/306//t /Z/P6 C Block No.
Project Name: 4Vz&0Du) 19004 Owe /T
OETAILEb DESCRIPTION`OF`W"O'RK. ._
2�1 e i vi/l/00-4)s "qz/o vcvens w ( n,7 � p.
CONSTRUCTI ONVINFORMAT ION
:=- - -
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:$ 7—F), ex-3 o Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 77?ty_AS Name: Jr-,rf- U.1PrLS 4A
Address: 7119 A/►L) Company: LI Q)92Ty L-Long_ rf30/C.berLS
City: Stater Address: 257 SE_ lYto.VM7-CX l?_`/
Zip Code: 3���b�' Fax: City: 5!-0Ag_T Stater
Phone No. '772 ZC,3 if I Zip Code:-3 4 Fax:
E-Mail: Phone No 7772 Z�'3 / / / 3
Fill in fee simple Title Holder on next page( if different E-Mail �IC�C�F,�yL r r �l/j2/�•4e%�!/�,r//, J��(wt/�
from the Owner listed above) State or County Licensee—(SSC x,5-0 q 15 7
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 LAW INFORMATION
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Ad d re ss: Add ress:
City: State: Ci State:
Zip: Phone Zip: hone:
FEE SIMPLE TITLE HOLDER: _Not Applicable /Addss:
COMPANY: _ ble
Name:
Address:City:
Zip: Phone: 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 p4URE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVE S T YOUR PROPERTY. A NOTICE OF COMMENCEMENTMST BE RECORDED AND
POSTED ON THE T BE RE THE FIRST INSPECTION. IF YOU INTEND T B Al FIN %""11JW
WITH YOUR LEN R A A ORNEY BEFORE RECORDING YOUR NOTICE OF N M �k ��//
Situ
r O see/Con actor as Agent for Owner ign re of Co ctor/License Holdirn;�� N�=�
= `�: n
TE OF A STATE OF FLORIDA ���'•'2 ���
COUNTY OF COUNTY OF '�i�`'•''.B� y' �.���
-'V R/Dq
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged �/ iteltlit�o"
this day of 3 ✓n-e 20LI by this day of 20_ by
Name of person makintf statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
.4�2
(Signature of Nota ate of Florida ) (Signature of Notary Public-State of Florida)
Commission No. yr (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 9
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