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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: !--� .�� Permit Number: ��5-10.1 n
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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
PERMITTYPE:
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Address: krcz J lac
Property Tax ID#:_/`h C)- ' ® � - U--v� Lot No. or r
Site Plan Name: Block No.
Project Name:
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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:
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Cost of Construction:$ ; 0 C Utilities: —Sewer —Septic Building Height:
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Name i', i1 T&QhnC f-VA(Q ,.. • ych Name:T � k%I f'_(' � i 5
Address: (9.0 1 L ) (J r ,eCt bC1C- Company: 0,/isl 1�7,�,CI o`I C •L v)C
City: �`_ rc State: j Address: i E t r C r! V-c
Zip Code: �J-T`1 �C1 Fax- City 0 1,,&, AJci ( y� Stater/
Phone No _IZ� "55�g Zip Code: Fax -72-),6&-q-4i77J
E-Mail: Phone No -72_ 46
Fill In fee simple Title Molder on next page(if different E-Mail (c i' Ve C vi C 6,1 - a JL-011 ('6113
from the Owner listed above) State or County License 011
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 ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDWG YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Cont actor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAS Lam(, STATE OF FLORIDA
COUNTY OF \ COUNTY OF
The forgoing instrum�►7t wps acknowledged before me The forgoing instrument was acknowledged efore me
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this day ofy ," 20 EALY this day of M )lL 20 2 by
a vis `bra In k -S
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced EL L Produced �L
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(Signature of Notary Publi �„qr, oridp 1LEN VA publ c ignature of No UGH N
:.State of Florida Notary `��PR,PG/,,
Commission No. C ?s ion # GG 27007 �_° °4� State of Florid No ry Public
�dmmission Expires mmission No. _* += mission=1270079
OFf )ctober 22, 2022 +� °e°�� My Commission Expires
nnn` i°oi�`� octobar 7 0
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19