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All APPLICABLE INFO MUST BE Co
Date:
ETED FOR APPLICATION To BE ACCEPTED —
/Z. O C(/ PermitNumber:
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Building Permit Applicati ,
Planning and Development Services to
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982sd4
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 9�Wsc
PERMITNPE: �'e �y�,.l 1C fLs,c(e n -fl�__
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID;
Site Plan Name:
Project Name: M o 2 N , A C' S , cLi_ A -VA .SE 11 A
I
Additional work to be performed under this permit —check all that apply:
Lot No. oW
Block No.
'' Mechanical _ Gas Tank —Gas Piping ✓ Shutters ✓windows/Doors
Electric ,'Plumbing _ Sprinklers _ Generator ✓ Roof /4112- Pitch
Total Sq. Ft of Construction: a2 % 9 Sq. Ft. of First Floor: a�/O �a�y
Cost of Construction: $ X��— LDS . Utilities: —Sewer V Septic Building Height: i5Z3
-0IAIIUER/GESEEE
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Name R n o , 41�, illr„ e.�L I lL.
Name: Q-I r r X01,2_
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Address:.J7,?S .S fn..s �r.an�/�( S„l7iEompany:
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Address:3725 S PA (�l06 n �'kaly l i �c Iv
City:.�r h State:
Zip Code:151 /(_p % Fax: '% 7.1 .
Phone No '%-% - 7d'rro
E-Mail �"- - Jn,7 P_CWu (�• f� F U.41? d am s.5 ce i
State or County License C//3 0_
City � �/,l (I A State: s- _.
Zip Code:�r� `�� Fax: `l1.1r /.,�1 l �l T_<
Phone No, `/ 7, J . / l A -
E-Mail: Rr to igq nib c r_ @ I?rr,'A17 P n)1, , CeM
Fill in fee simple Title Holder on next Page (if different
from the owner Basted above)
uc VI cons uc ol, is y&WO ur more, a RECORDED DED IVOiI[e 0f 4.Ommen[emen[ IS required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement Is required,
'fiI� O ISi1'A1 �1 ofi�, `1, �..
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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: Applicable
Name:
_Not
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permitto 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 INPROVEMENTS 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
wrrH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT_"
/ r I-/OCO
ssee/Contractor as A
STATE OF)FLORIDA
COUNTYOF (5-
The forgoing instrutpt was acknowledged before me
this�dayof T! ! 20 11by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Pro ced
igna of Notary Public- State of &tK1 %%OWE
+°"�"•'B�,b Commissi #G 10465fi
Commission No. idea P021
9 Q Expires Mny
fe _5 5'dedThw Bud9etNDW1"03
REVIEWS I COU TER I REEVIIEW I SUPERVISOR REVIEW
FRONT
RECEIVED
STATE OF'FLORID�
COUNTY OF Luca e�
The forgoing instrujnent was acknowledged before me
this 43 day of 20 )r by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification —
Produce d� d^� �'
r "d'
(Signature of Notary Public- State of Florida )
Commission No. ' Y,',�kc (VMPASROWE
t Commisslon#GG104656
PLANS I VEGETATION I SEATURTLE I MANGRO'
IEVIEW REVIEW REVIEW I REVIEW