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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Act, I'm
_ Building Permit Application
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
PERMITTYPE:
PROPOSED I'M' R01/EMENT LOCATION.
Address: 06Q l ��ttna�—S (Z� -PCca2.E5
Property Tax ID#: l301 G,(-�,? 2025" 0,20,!f) Lot No. 2-g
Site Plan Name: 2-C� t Block No.
Project Name: 1>
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATIDN:
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 WIZ A- Pitch
r-tom
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ l Utilities: —Sewer —Septic Building Height: S�o
OWNER/LE:SSEE: CONTRACTOR:
Name PAvrb IDA LU-CkC-(e_t-3 Name:
Address: Sf[Jc>t ��ft(N'�� Company: cam rr,."6,(.L"�"fNH LA-4(,
City: J:::�t Y20'e ' State: F7 L Address: 2"7 Z '1)LeAY J ,A-Jjg�
Zip Code:?r{� $`l Fax: City: 1't Pr.�2 Stat e:_f
Phone No. Zip Code: 2�45Sv Fax:
E-Mail: Phone No :7-7-2-
Fill
-7'ZFill 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:_ _�',1 Lw �� �,�c� �r`sc�- Name:
Address: Address:
City: I�C Pca2-�� State:� City: State:
Zip: ,4.4575 Phone Lwz li60 -7Z�r( 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 thepermit 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 IMPROVE S TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON TH OB RE THE FIRST INSPECTION. IF YOU !NTEND OBTA FINANCING, CONSULT
WITH YOUR DER O AN AT-FORNEY BEFORE RECORDING YOUR OF COMMEN EMENT."
Signature of Owner/-Lessee/Contractor as Agent for Owner Signature of tractor/Li
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instr ent was acknowledged before me The,jprgoing Inst ent was acknowledged before me
this P day of \V 20L by this) ll day of m (\� 2d_�_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
KoSi nature of Nota Public- a p ����� --� '"— Si nature of Notary
Lb'cam r
g Notary f� g Y =. I
= GR4M-
�,,IX pUq LASHAHNA INGRAM-RAHMING RAHMING
..;yc A, r :* MY COMM S[
Commission No. r MyISSION#GG27a060 ommission No. :,._ e�({#GG 275060
_N EXPIRES.Uece ber-20,
EXPIRES:December 20,2022 pF F�q,,' Bonded Thru Notary Public Uedenlriters
....0. otary Public UndelvAerS
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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