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All APPLICABLE INFO MUST BE COM FETED FOR APPLICATION TO BE ACCEPTED `
Date: 31 [)P- 076Iq Permit Number:
1`1�a^OSGa.
RECENED
a
- - - Building Permit Application
DEC 311019
Planning and Development Services
ver6ttkr9 D P n Yent
Building and Code Regulation Division
St. was
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
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PERMIT TYPE:
PROPOSED 110 P. R OX, E 10 E N [TO LOCi4TION:
Address: zil l -7 PA(^oLj i 112II?�l(l'i
Property Tax ID #: 3 LA 0a "COO (E2-T)0` 0 `�
Lot No.�
Site Plan Name:
Block No.
Project Name:
DETrAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional workto 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: ?2 Sq. Ft. of First Floor:
/4
Cost of Construction"�$ 7 Utilities: —Sewer _Septic
Building Height:
OWNERMESSEE: CONTRACTOR:
Name IIDwLANQ Name: A L q d PrO
Address: VoLnNA o Or- Company: Y6mte
0�"fir lQ f3u�L !
City: Stater Addr :. `i I-7 is � q
Zip Code: Fax: y: sow u� ". "
e:T/v
Phone No. 3 zip C e: 3
Fa:
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E-Mail: ( i abh fIi r'GY✓h`"=_Phonei „r�� 3
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Fill in fee simple Title Holder on next page ( if different E-Mail - R ^
c'r� we JA 10,
from the Owner listed above) State or County I is se
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.
FARP1110LC SIT] R
DESIGNER/ENGINEER: _ Not Applicable
Name:
0
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: Application is hereby made to obtain a permit to clothe 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 RECORDING YOUR NOTICE OF COMMENCEMENT."
URSA5&i2g)
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA �1 L_
STATE OF FLORIDA
COUNTY OF (S /— Ci'c�
COUNTY OF
The forgoing instrumen was acknowledged before me
The forgoing instrument was acknowledged before me
this � day of �0 20 /i by
�(
this _ day of 20_ by
`
?l yid k n L3N_0_UD
Name of person making statement.
Name of person making statement.
l�
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificatiop..
Type of Identification ..
Produced Pit— im-
Produced
(Signature of Notary Publ - State of
(Signature of Notary Public- State of Florida )
,`�+Q}}}}W�Y�P"�cELLS
Commission Now m
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tery Public
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VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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