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ALL APPLICABLE IINFOr MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 01 Permit Number: � 'd 53 S
42ECEIVED
AUG 2 6 M19
Building Permit Application
F i I
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential k
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lineTn-
PROPOSED IMPROVEMENT LOCATION
Address:
Legal Description: 2 4f 3 7&, n 2 Sir 7�5�Shov�H / a 1` �3i 1-�%:5!�--
PropertyTaxlD#: l ac'.Ql aS z2 -rj-ao `d Lot No. a�_O'
Site Plan Name:. %�i�1 GJ`f �� <`c� .c�lC f '* Block No.
Project Name:
Setbacks Front Back: Right Side::* Left Side:
DET
AILED DESCRIPTION OF WORK
CONSTRUCTION INFORMATION:
Additional wor to ae e rme under this permit-check a appy:
HVAC 11 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric Plumbing Sprinklers Generator t�Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ l Utilities: Sewer i l Septic Building Height: _
OWNER/LESSEE CONTRACTOR ..._
Name he Name: cr C
Address: 6 Company: c Y&I/L_
City: ieUG2s State: Address: Lcki=e
Zip Code:�3 1Fff�)- Fax: ,/(/�/� city: �f 1� � Statr�e-
Phone No.77s� �'��y Zip Coders - Fax:-7 7�-"71�v
E-Mail: Phone No.
Fill in fee simplertle Holder on next page(if different E-Mail: Kce a �d
from the Owner listed above) State or Coun 'cense:
if value of construction is$2500 or more,a QECORDED Notice of Commencement is required.
r
DESIGN ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City' State. _ Chy: State:
zip
Phone: Zip: Phone:
FEE SIMPLiE TITLE HOLDm- ' - Not Applicable BONDING COMPANY: Not Applicable
Name:.' Name:
Address: - A,ddr+esx -
City. City;
Zip• Phone: Zip: Phone:
I aertifjr that no work or butdlat3 m has commenced prior to the lmmance of a penult
w�h'md�m ids in oo nmatoes no� that isgrarmtfirmg a emmdt the holde:to build thesubfecc cEure
�� with m once Owners Asa atlon ru "b%:ge an�asv that may restrict or suds
stmmcture.Please commsultavvikyour Home Owners Ammon and reulewyour deed any restrictions which may apply.
In eandderation ofthe granting of this requested permit I do herebKagree that i v4lL in all mwec'ts6 perform the work
In eccordam ce with the approved plans,the Florida BuHding Cafes arrd St.Lucie CountyAmvWhmeft
The foliowing'b *ft permit applications are exempt from underang a chill concoye y review:room additions,
accemy stnicha rt,swimuft p00%fences,waft screemzroonand accessary uses to another non-reddemtlal use
WARNNtG TO OWNER:Your failure to Reoard a Notice of Commencement mW remit in yalivuytng twice for
lm rovements to your Anaperty.A Notice of Commencement must be recorded and hosted on the jobsite
bere the first inspection.>f you intend to obtain finan�angi,caonsult with fender or an attorney before
commen work or recordin our Notice of Comrinertce»fle
S gnature of Owner/Agent/ signature of Contractoi'Akvm Hoidex-
STATE OF FWRIDA STATE-OF RARIDA r
COUNTYOF C0UNiYtfF
The t batmmermt was ad mawledged befoae me The hatr mmne nt was admowtedged before me
this dayof - 2: A by this dal►of � .20by
/„��
f+�"Of II�IIY�I�I/IgN11���r�
t1ameofperson admGw )
(Signature of Notary -State of Florida) WVa'hn ofN bila-State of Ronda)
--
Willy Kown n � ORProduced Personally Known t
Typeof idem"cation Produced Type of tdermtifi
D GGsVIVO 4 �;�� IRES' ���eis j
nunisslon Ni�� CYcnro{�,�y{r�i6,PLja, Commission Na.Tur
.ii�•• •?i V"` 1�� N?F}i^" - _ •tifiN-y - -
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1
Revised 07115128 "m"'"•- -
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