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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED-
Date: 1 a3�a� Permit Number:
RECEIVED
:. 14N . 3 ?(l20
Building Permit Application
Planning and Development Services CpuntY, L'eFtltting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462=1553. Fax: (772)462-1578 Commercial Residential
'PERMITTYPE: �j .1
PROPOSE► FMPRO EM ANT LO 10 -
Address: S6O_,�-
PropertyTaxlD#: '`�da'� 1d'��31- 1oo- � Lot No.
Site Plan Name: Block No.
Project Name:
T& LED EmCRiPTI M N OF WOR
w I rz e Lo-t 1-k- s'T v C_cd .
CONS RUCTION I FORMATION:
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:
Cost of Construction:$ �TZ- O 0 Utilities: _Sewer _Septic Building Height:
OWNER/LE1SSEE: OWE NRACTOR:
Name P,,00 Lf=a 11 fi Name: Kt�.UL_ C-US't kL -.0
Address: 904 Qscr=n z_& DY.- Company:" &U iL aJw6
City:�r- State:Tq- Address: 26PI Su) =a-,LPt:s�t't
Zip Code: `&,_ z Fax: City: (moo rcT- S� Lu c(E .State:
Phone No. Zip Code: 346t,917 Fax:
E-Mail: Phone No Z61 6 8,�' S3:rz-
Fill in fee simple Title Holder on next page(if different . E-Mail �UN� c� •r1 A P-ao_4 of dun cc) CD rn
from the Owner'listed- above) State or County License GGC. 1 S 1.l 6q "?
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.
S '''PLEMENT L CONST� CTION I�N L.AW IN��ORMATIO ;
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 her 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."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF &A-- COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Q�!> day of�lg n 20 a„a by this;- day of 2016 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifica ' n Type of Identification
ProducedProduced L L
(Signature of Notary lic-State of Florida) nature of Notary
Ng g #GG
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