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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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MCEIVED5
61
4 , 1019
0-1-
JUL---
• _ Building Permit Application permitting Department i
Planning and Development Services St,Lucie COUnty
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Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
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R�OPO, 09)f11N EMENT LOCA ION:
Address: 5300 dw I,fJnlnl apA
PropertyTaxlD#: ��J03_soa- oao9-�oo�a
Lot NO. ILJI�';r �LIIQ
Site Plan Name: n Block No. Jar 19_nl
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Project Name: Jed)36)�, L
DETAILED DE�S�R�'PTtON IO�E WORK:
WOW) �tA/( C K r3 v(,k I es t6 c o s r �20t;r o P �7,K I
,P72-0 140 J Z.OAly Fear %vatic,
CONSTRUCTION1N.i=0RMAT)ON:
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:
OWNERfiLE+SSEE: CONTRA TOR:
Name O13crzi- a.4a 1. j Name:
Address: .5306 .AIlkl & AI,JJ /<'046 Company:
City: bzexc"ec.8 State: 11�b Address:
Zip Code:? /nFax: City: State:
Phone No Zip Code: Fax`.','
E-Mail• QL l 10 0 1,9 7d 1? 6-0Y17W?-r Phone No
Fill in fee simple Tit4 Holder on next page(if different E-Mail
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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.
NWIFIRMENT, RNAMA2LC«ONSTRUCTI N LIEN LAW tNFORMATI�
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 IM ROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THEVOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIT
Ji YOUR E R OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign ture of vJ er/L ssee/Contractor as Agent for Owner Signature of Contractor/License Holder
S ATE O FLORI A STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20]C 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 IdentificatioType of Identification
Produced �'L� Produced
til/
(Signature of Notary Publi -State of Florida) (Signature of Notary Public-State of Florida)
Commission No. ELLE(6lr AUGHN Commission No. (Seal)
;=o c-State of Florida-Notary Public
*_ Commission # GG 270079
y ommissi nxpires
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