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DESIGKR/ENGiNEER: --- Not Apllil4.1ble I MORTGAGE COMPANY: Not Applicable
Marne: _ tV.irttr }
asic�ii r�;:
Address: State:
Cttl- _,_,. State: City:
Zip. � F'tto, —nf^ Zip:Phone; -----•---
FEE SIMPLE TITLE HOLDER.: Not Applicable � BONDING COMPANY: �.. ^Not Applicable
Name: Name.
Address - - - - Address:
City: City:
up: Phone: Zip: _ phone:
OWNER/ CONTRACTOR AFF{DWfT: Appl:cation is hereby made to obtain a permit to do the work and installation as indicated.
t certfy that no work or installation has commenced prior to the issuance of a permit.
St, tq%v County no representation that is granting a permit will authorize the permit holder to build the subject structure
afirch is k-% ct wnttr an applKabte Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
str=lixe Please conssu t with your Hone Owners Association and review your deed for any restrittions which may apply.
.n conuderawn of the granting of ibis requested permit, l do hereby agree that I will, In all respects, perform the work
*n accZrtsarrce with the approved pians. the Florida Budding Codes and St. Lucie County Amendments.
41*e `oiA�%-g "J,_,xv permit applications are exempt from undergoing a full concurrencY review: room additions,
accrssorY structures, sw► "mng pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
-"ARMMC TO OAR- YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TVgCE FOR 111WROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOEI SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WTT" YOUR L04DER OR AN ATTORNEY BEFORE RECORDING YOUR !NOTICE OF COMMENCEMENT."
Sy -a' _,e a` C.. -, ./ Lessee/Contractor as Agent for Owner Signature of COntrattar/Lifense Holder
STATE OF FLOPJD STATE OF FLORIDA _P
i�
COUNTY Of _ Cti11 _ COUNTY OF _ --
d�Y+±�s , ckno� ledsed before me
GA 20-1-0 by
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ftc,ation
Produced
ature of Pu St to of Florida I
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j ERVISOIRI pa ViGETATIQN ! tf r
' W It ti REVIEW IiLVILW it - VI
The I rc+g Instru ent was acknowledged before me
this` ,bay of ���, 2p'j� by
YL Yi i
Name of person making st ement.
Personally t(nown Oft Produced Ident�flcation
Type of IdentifiCazion
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
e
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
I
oo-�
ED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential / .
Address: --
Property Tax ID #: V-10-7 - 201 - ()b t-o2 - 0(')(j - LP _ - _ Lot No. ____-
Site Plan Name: dr(Avesi w t'1,--.e-1 Qy' -- - _ _-� Block No.
Project Name: 0V\dY41til W�1 e�2l.Qi/ ---�-- - -T
DETAILED DESCRIPTION OF WORK:
iZp- Ypo-c '%1n\Y-)Ql . fib
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 Pitch
Total Sq. Ft of Construction: 3:1- z Sq. Ft. of First Floor: -3`I I.9
Cost of Construction: $ , Ly Z 59 Utilities: _Sewer _Septic Building Height: _
OWNER/LESSEE:
CONTRACTOR:
Name
Name:p ho if i
Address:2Dl7_DSOI�d_�r-
Company: 5
City:. ?1e1ri^P_ State: Pl.
Zip Code: 3LOLI I Fax:
Phone No.-J-1 2-1-I_Q�- -1 9 I.L4 _ - _
AddressAl75Q US �1A),1 �}� 3Q�
City: J3ulw ey State.n
Zip Code: 3341-1 Fax:
PhoneNoi-IQI-i42g1z,
EMail:()u�ln�P_1t ��QMa,l•CDVVI
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License L4
It value of construction is 52500 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.