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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' �D Permit Numbe.. a,a LJ
VED
Ln
9i�20
Building Permit ApplicatiPlanning and Development Services ty, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE: —�
P RNPOSED IMPRXYZ EMT, ENIII LOCAT UKN'
Address: ^ P e /`1 Y .�
Property Tax ID#: pC3l� � 7 ^���7� ��Qfy Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DE-SCR�IPTION QF WORK:
PG
CC3N5TRUCTION tNFORMA ION:
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:$�wed • Utilities: _Sewer Septic Building Height:
OWNER/LSSI*E' C!0►NTRAC�IT+R:
Name �^ Name:
Address: Company:
City: ` State:_ Address:
Zip Code: Fax: City: State:
Phone No. oZ- 0ma0 - Zip Code:- Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on nexYpage(if different E-Mail
from the Owner listed above). State or County License
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.
f
VS-91M900 0
L CONS SUCTION LIEN LAW I F� ATI'O
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 willl�in ali,�espects; 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.",
Z Zee-.g
Signature o Owner/Lessee/ ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA ♦ /���� STATE OF FLORIDA
COUNTY OF •JJ' COUNTY OF
The fo� ing instrument was ac nowledged before me The forgoing instrument was acknowledged before me
this day of Q C 20_.Dby this day of 20_ by
Qc__C a C L O v%
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificati n Type of Identification
Produced Produced
(Signature of Notaryrkalite Qf F§grda) (Signature of Notary Public-State.of Florida)'.
DEAN A IE GIVENS
{� '� Commission No. (Seal) '
Commission No. � MYCOMiIM r111#GG 022023 I
r d EXPIRES:December 16,201
'FOF FISP, Bonded
REVIEWS FRONT ZONING SUPERVISE PLANS VEGETATION'
SEATU_RTLE' MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19