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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION.TO BE ACCEPTED
Date:' gc 9W :2019 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITAPPLI
Address:
Legal Description
ON FOR: Q
[,of 5
Property Tax ID #: 3'i PJ — �6;
Site Plan Name:
Project Name:
Setbacks Front Back:
RECEIVED
Building Permit Applica ionFE 1 7920
ST. Lucie County, Permitting
Commercial
u y�_. '<Or-T
>a �a I C�eC� S Vb I�
Right Side: Left Side:
Residential K
Lot No. 5
Block No.
rtaamonai worx to ue penorrneu unuer tnu, pernnL —cnecrt do urdL dppry:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric _ Plumbing —Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Coster ��t� i_(d (%e) .
Sq. Ft. of First Floor: _
Utilities: _Sewer _Septic
Building Height:
Pitch
.OWNER/� SSEE:
CONTRACTy�„R:
Name Unep, \. `.
Name C0 �'N¢hre�...
Address: iK Saddl25ur
Company: -
City: Pd4- �O I A I-tl GIC __State: %
Zip Code: )qO(O Fax:
Phone No.
Address:_��\�
City: oRP\ems. State:_
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Q ooksAfo Q2 gd, co m
State or County License C Pc - 65T355
If value of. construction is 2500 or more, a RECORDED Notice of Commencement is required.
P LE ETA CONS IQ LIEN W INFOR
DESIGNER/ENGINEER: _ Not Applicable
Name:
10
MORTGAGE COMPANY: n
Name: Mtil �ldrtct9
_ Not Applicable
Address:
Address: Po bon o?
City: State:
Zip: Phone
City: t [aAA
Zip: 33roa-MgPhone: 663-6bB-
State: .
3333
FEE SIMPLE TITLE � 10LpER:
Name: �ninee1
Not Applicable
MALV"J
BONDING COMPANY:
Name:
v"Not Applicable
Address: 96k5 Sa,VAl4 mt)_d
Address:
City: d( LnYLu' PI/
City:
Zip: e`Ik86 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 Counttyy makes no representation that is granting aipermit will authorize the permit.holder to build the subject structure
which is in co 1%ct with'any applicable•Home Owner3 Associatidn 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 jobsite
before the first inspection. If you intend to obtain financing, consult with I der or an attorn efore
commencingwork ar recordin ou Notice of Commenceme
Signature`of Owner/ Lesse ntractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTYOF
STATE OF FLORIDA�
ST7 L.VCI9
COUNTYOF
The forgoing instrument was acknowledged before me
The fo oing instrument was acknowledged before me
this ri day of yj nu a 207 by
this T day of TQq 20�•t by
nn ,,
Ah2-P—[ AL vn,_
%Pn \/
Name of person making statement.
Name of person making statem nt.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced EC__ln 1
(S' nature of Nota a e o ICK
; 4'-•"MYCOMMISSIONOFF9=8
(Signature of Notary b.aPp rida
Commission No. a �:, ThES H tY11twa �0m
r1P . E
Commission No. '-' fi Scat of Fl�� U
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REVIEWS
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PLANS
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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