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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Permit Number:
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Building Permit Applicaon 828Planning and Development Services
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Building and Code Regulation Division Fpall
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2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ✓
PERMIT TYPE: � I S H I N 6i 1_E --o M IE-M-L
Pft POSED IMRCl.ffiEMEN C LLl 10 N,
Address: Mctl Linfth 41M AVt FOO
11AI-Mt . rl 349W-
Property
49 2
Property Tax ID#: 7-Y 2.q ' bo�- OI3--' 000-Li Lot No.
Site Plan Name: Shttl Q.r S.Id�C1G� Block No.
Project Name:
DEVIP0.,,6 •CRHaA ON OIZK.
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CONSTR1UCIT,II V I FORIMIA I•N: ME—
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 /Z Pitch
Total Sq. Ft of Construction: gT00 Sq. Ft. of First Floor:.
Cost of Construction:$ �, Utilities: —Sewer _Septic Building Height:
C}1NyI:E7RfLESSE 0, CCINTR OR 14
Name ��� S / Name:J%APfW IAA9-TIPI��
Address: J'I�� f L 1444 kc, e Company:T0i'O�I R-OOf6r1C1 S�S-I�S SSG.
City: Aa l ewc,{ State:r Address: 37-01 sI= Komi MCA TerraCe
Zip Code: 3 Fax: City: Si U Q rk Scat-ante: KL
Phone No. 174-- ��� LEO 3 Zip Code: SLAQT- Fax: Vz-p7 Z' 3033
E-Mail:,/46-2 S /�� �% µ40N _e0r'G Phone No 77 2-g 2' aa✓'��
Fill in fee simple Title Holder on next page(if different E-Mail &fVn1!4+04G1 r •n S S el,?S•IU
from the Owner listed above) State or County License LC C 1330:? g
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.
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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 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 ONTHE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND T OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE.RECORDING YOUR NOTICE OF MMENCEMENT' ':. -
Signature of Owner/Lessee/Contractor as Agent for Owner Signature Contractor/License �er
E OF FLORID S E OF FLORI A a
N �g NTY OF �PGIl� OUNTY OF n q o
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Zh orgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
00 1 ay of FGhrUU6&ey 20 20 by this 7�dayof kL1A(4"7 ,20za by _ U o"
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N of person making statement. Name of person making statement. z
.-T nally Known roduced Identification Personal) Known OR Produced Identificatio
of Identification Type of Identifi
Y ced7,
Produce �,.,,,,,,,,,
(Signat a of N tar'Public-State.of Florida). .' (Signa ure of Notary Public-State of Florida)
Commission No. /,rLrl�/ 731 ` '•(Seal) Commission No. �f! q 7 3 I (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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