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All APPLICABLE INFJ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
'Er
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Lldi
ED
Building Permit Applica Jon
JAN 15 2020
Planning and Development Services Permitting Departmen
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 �t. Lucie C t�, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resl en la
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID#: O - ® - t�"b Z O -0 Lot No.
Site Plan Name: o,(& - f ` Block No.Aq-
Project Name:
DETAILED DESCRIPTION OF WORK: t
CONSTRUCTION INFORMATION:
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 &A a` Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor: ZIS_3_1 7
C � � l
Cost of Construction:$ �, b -o Utilities: .- Sewer c Building Height:
OWNER/LESSEE: % ; CONTRACTOR:
Name iLL' - Ce— Name: ('
Address: -Lc) Af-17p�,eQjC ompany: DfLo cxn f'�l����oc����P/iC37
City: 'q _5 L-<[ State:ia— AddressZl� S_i-�' t5x(.'C(i,q r5fc�
Zip Code: 1 Fax: City:qb55e- L L/C t. S ate:
Phone No.
nZip Code:Jyq�Z Fax: 49
E-Mail f C 10►►'k Q 4C(o C�1n.Srj, c -r>�Gl ,.C't�< Phone No -777_-3,
Fill in fee simple Title Holder on next page(if different ¢E=Mail 9�1a�✓ c,�n a Cn n ST�c�CT»a�o Ca
from the Owner listed above) State or Cbunty License 61cc � 7
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.
$UPPLEMEN�'ALCO�iSTRI;l�t7Ul1Il.1�t�ILAtl1ll�il+£}RMAT�ON. � x:
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DESIGNERJENGINEER: Not Applicable MORTGAGE.COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip; _ __Phone:
FEE SIMPLE TITLE HOLDER: i _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: Gtys
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 Coun�y..makes no representation that is granting a permit will authorize the permlt holder to build the subject structure
which is in co►�flict with any applicable Home Owners ASsoctation 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 Coiuity Amendments.
The following building permit applications are exempt from undergoing a full tancurreniy review:room additions,
accessory structures,swimming pools,fences,.walls,signs,screen roams and accessory uses to another non-residential use
"WARNING TO OyfNEIC YOUR FAB.URE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT iN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY: A NOTICE OF [ONMENCEminr MUST BE RECORDEiD AND .
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTiON.IF YOU I TEND TO OBTAIN FINANCING,CONSULT
'WITH YOUR 12NDERMR AN ATi'ORHEiP BEFORE RECORDING YOUR.NOTICE OF COMMENCEMINT."
/,1,Afof
Si a of Owner/Lessee/ 6tractor as Agent for Owner Signature o Contractor ceps Holder
STATE OF FLORIDA STATE OF FLORIDA
4 COUNTY OF St Lucie COUNTY OF St Lucie
The forgoing instrumentwas acknowledged before me Thefcrgoing instrument was acknowledged before me
this 10 day of Janua1y ,20-20 by this 40. day of January 2o-2}by
Mame Of person making statement. Name of person making statement
Personally Known_ XOR Produced Identification Personally Known_ X _OR Produced identification
Type of Identification Type of identification
Produced Produ bww
Y
{Signature of iV Pu lc= g Signature of lil r d State of plotida
,�`,•*• NDY WjBB Commission#GG 312394
rte'Nota Pu Tic-State of Florid �* ` . My C . n Expires
rnm'►ssion No. -y 2023
Gommiission N . •� Ron GG 312334 `jhx/n*�`
e/n�'`�` Y>� mmlSsion Expires.
REVIEWS FRONT ZONING SupERVISO PLAi}1S VEGETATION SEATURTLE MANGROVE
CQlllft REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE.
RECEIVED
DATE
COMPLETED
Rev.2/7/39