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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12 -D 19 Permit Number:
G r , CDE1
Building Permit Applicatio
9
Planning and Development Services mitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
P '!as!
Address: 2 4 6 J
Property Tax ID#: 2320 Sol 00?�j• ()10 Lot No.�
Site Plan Name: Block No. 2—
Project Name:
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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 _Plumbin��g�� _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: 1106 St, Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
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Name T'h e RE Zlose_vb clespi Name: )Q LAyvis + V irdL MAO
Address: 24161 S. l5rodWroli Company: 'rUUp LAINkS (f2YK11 J1My TP(.,
City: _FORT P I Ep of State: K I Address: 150qq I
Zip Code: 3 U C)'4 S Fax: City: FT P 1 E PICC State
Phone No. 772 , 4b C 0190 Zip Code: 3 49J 4 S Fax:
E-Mail: Phone No 7)-L 979 04,6S
Fill in fee simple Title Holder on next page(if different E-Mail LAOSSCA PE io BP,11,smAh . N FT
from the Owner listed above) State or County License se—_ 90 74
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.
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 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 Counter 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."
_.ice
Signature o wner/Lessee/ ntract as Agent for Owner Signa re of Contractor/License Holder
STATE OF FLORIDA I STATE OF FLORIDA g
COUNTY OF � .L Uc IP COUNTY OF d 1_.L)t 1'e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisll day of -J)EC E M P,EQ. ,20A by this-27 day ofDFf F MBE-.I?_ .20A by
Lb1WF_ DkArvby _JA
iNE DRQu� I
Name of person making statement. Name of person making statement.
Personally Known X _OR Produced Identification Personally Known )� OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Sign re o otary Pub �9rA4� fFlorida-Notary Publ JmgnatbV-b ofN ary P#rp ori FANYFORGETCommission # GG 22409 State of Florida-Notary PubliCommission No. 22 �� {1; �pmmission Expiresmission No. ? Con(ft0 on #GG 224098
ep ember 29, 2022 . My Commission Expires
September 29, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.2/7/2019