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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 " Permit Number:
to
Nov 19' 1019 I
,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
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PERMIT TYPE:
R, 19 0 I MWMEN,
� t7UEMF7 o 'N
Address: l D O D A]LOV d'
Property Tax ID#: I o� n' Dg n®D/ CJ Lot No.
Site Plan Name: Block No.
Project Name:
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T'UC If�� 'I�FC*?REVI C)N•
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:
cv �
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OW LR 1@115111.
Name Name:
Address:_ _/�'Dj�r5n �Gi! - Company:
City: / � 101(:rc_P�6:�� State:/='li. 'Address:
Zip Code:_3 ��r/ Fax: City: State:
Phone No. 71 da G d Zip Code: Fax:
E-Mail: e r Ga Phone No
Fill in fee simp a Title Holder on next page(if differen Mail
from the Owner listed abo ie) State or County License
If value of construction is$2500ior 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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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 AFFIDAVIT: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 YOUR LENDER:OR AN ATTORNEY•BEFORE"RECORDING.YOUR.NOTICE OF COMMENCEMENT_".
gn ture of Owner/ es ee/Contractor as A or Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF (A- pLe--, COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_&3day of l)ID/ , 20_ff 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 Identification Type of Identification
Produced Produced
(Signature of Notary Pu c- tate of Florida) (Signature of Nota_ry.Public-State.otflorida:)_ , -
����wY Co mission No. - Seal
Commission No. .�P ISeALLEN VAUGHN �" -
o_ tate of Florida-Notary P blic
*= Commission #GG 2700 9
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''un,ar ctobersion xpi eSO
REVIEWS FRONTANS " VEGETATION _ SEATURTLE`�._- -MANGROVE
COUNTER REVIEW REVIEW --VIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.