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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
::)UMTyI
Permit Number:
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
x
Address: XS-L A c�Vi 21) Qect cn I 1— 3 �i 9 � A --
Legal Description:'; iVf-/ l�r���� �� k,
Property Tax ID #: y St ( - Y s- d O l Z- 0 O0 — d Lot No. 7S
Site Plan Name: t--\Cklq\V`�f
_O\; Block No. 44
Project Name:
4 Cc3 \Q d A
Setbacks Front Back:
Right Side
2
Left Side: I
DETAILED DESCRIPTION OF WORK: I
,Q_ Vq
CONSTRUCT#ON INFORMATION:
Additional work to be Derformed under this permit- check all apply:
11HVAC LJ Gas Tank
11 Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 3 t-S i ZV
as Piping
Sprinklers
_ Shutters Windows/Doors
Generator Roof
S Ft. of First Floor: _
Utilities:n Sewer O Septic
Building Height:
Roof pitch
OWNER/LESSEE:
CONTRACTOR:
Name t_&G.J�f �� V 1 v�N
Name:
Company: FHIA,LLC
Address: 3044 SW 42 ST
Address: &-_ Aqua -.y -�,V
City: ±�h State: =`
Zip ode: TzJqY--]- Fax:
City: FORT LAUDERDALE State: FL
Phone NO.-jr -L5S- `o&A'l
Zip Code: 33312 Fax:
E-Mail:
Phone No. 954-884-8500
Fill in fee simple Title Holder on next page (if different
E-Mail: PERMITS@FHAPRODUCTS.COM
State or County License: CGCO61890
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNE
Name:_
Address:
City:
Zip:
X Not Appl
State:
Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: 3044 SW 42 ST
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City: FORT LAUDERDALE
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
Zip:
Phone:
UWNLR/ 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 Comrpencement may result in your paying twice for
improvements to your property. A Notice of Commence u be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financi with lender or an attorney before
commencing work or recording vour Notice of CommA
Signature of Owner a Contractor as Agent for Owner
Sign re of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF- J<o. �j LvUg_
COUNTY OF _' T Luc!-c
The forgoing instrument was acknowledged before me
The for oing instrument s ack wledged before me
this j:Iday of 207-0 by
this, day of 20 c;C7 by
Name"Jof person king statement
Personally Known OR Produced Identification
Name of per making statement
Personally Known r OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of t rP IC;* atR6tfi"WMib - State of Floridak7(SignatureCommission
N 2mmli�n # GG d71722n
or,��. EXPIRES April( 2021
���11
My Comm. Expires June 9,202
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DATE
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DATE
COMPLETED
Rev.$/2/17