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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / 1• )a- M Permit Number: F;;. �r
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WON—W W-o
Building Permit Applica
rnitting Depart.
Planning and Development Services
Building and Code Regulation Division St. Lode County. FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 . Commercial Residential
PERMIT TYPE:
R��Oi*Dt[ P�RE _lLCCAT[C}IVf _.,. . .. . -AIM
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Address: laeto 4V '�h� �hu� , ��� �,���e � fY9$v9-
Property Tax ID#: r C/ 1�7)/ y t� ,/"S ZLe)q Lot No.
Site Plan Name: Block No.
Project Name: -YeF;= IaAr-k
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Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping- _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof '1i"-I- Pitch
Total S Ft of Construction: '606 �Ya- FL,t Ser-G c
Sq. � Sq. Ft.of First Floor:
Cost of Construction:$ % 000' Utilities: —Sewer _Septic Building Height: /a
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Name I)
S Fr �A/`c1" Name: ., r', h,,, k" .r+1'k
Address:1006, bd /s� J'4 r Company: Co.ti 44,4 J-- S�rw 'c-
City: Jr,-, 4- ()"e r' Stater Address: A91+' ' L-r•,',i a'0. A p/1
Zip Codej'19q.2- Fax: City:kerr"f.y :.;s(n'J State:)5q
Phone No. Zip Code: 3 VYJU Fax:
E-Mail: Phone No o00 - 3�t")•-190 2-
Fill in fee simple Title Holder on next page (if different E-Mail ,ec Kc r t,- .25,25' 6- AcZ
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.
SU!PPLEaMENTAL CONSTR CTIONL ENLA'W 1NFORIVIATION:
DESIGNER/ENGINEER: _Not Applicable
Name:
MORTGAGE COMPANY: Applicable
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: 1 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 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_YOM LENDER OR AWAPORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
nature Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF -5T �&6e COUNTY OF
The f instrument �s a knowledged efore me The for oing instrum nt was acknowledged before me
this day of 20by this day of t 20_q by
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Name of person making statement. Name of person making statement. m o o a z
;¢ CO,V' LT c
Personally Known OR Produced Identification Personally Known OR Produced Identifica
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Type of Identificatio L Type of Identificatio a .y W
Produce Produced.
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(SUnaturetayy Pylic-Sa fg t11 JOHN ( ure c-State of Florida�yQMYCOMMISSION# r 2, �� 1 EXPIRES:September ,2427 (�C ", e`al) Sion No.�J (Seal)
wad Thru Notary P
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19