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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION
Address:
Legal Description:
'S
Property Tax ID #: 130 -to t3- (X29 /- 000 Lot No. 2�
Site Plan Name: Block No. /Jq
Project Name: M\6acto' fit, :Jell`(\\ 1�ee_ 1c i sod)
Setbacks Front Back: Right Side: Left Side:
D'ETAILED DESCRIPTION 'OF WORK:
CONSTRUCTION INFORMATION
Additionalworktobenertormedunder this permit— c ec all apply:
❑
HVAC Gas Tank Gas Piping _ Shutters Windows/Doors
— ❑ p g
Electric 0 Plumbing Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction:
OC"
Cost of Construction: $13 0(p —
S Ft. of First Floor: _
Utilities: Sewer Septic
Building Height:
:OWN ER%LESSEE
CONTRACTOR:
Name i \C ae OQ Ali eA_ 1C 1 n5
Dame: L U CRS 6e-a
Address: \ CA&eq fYVf0Ue
Company:'Cs c a n :T:—y
City: L State:r'
Add ess:Y6,P C bif e el Ue
/e
Zip Code: � �tlfs/� Fax:
City: GtC State: .
Phone No. 61�7 - IOO19- ,00
Zip Code: (( ``
`C Fax:
E-Mail:
Phone No.5% I - -7 03 - 3QQ 3
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License: )6 2232
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL.CONSTRUCTION LIEN, LAW INFORMATION:;; ,
.. ...
DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name: 17/1
Address:
Address:
City: State:
City: J State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLD R: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name: I I
Name
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 jobsite
before t)e first inspection. If you intend to obtain financing, consult with lender or an attorney before
commeficine work or recordine vour Notice of Commencement
Lessee
Sierra urelo reactor/License Holder
STATE OF FLORIDA I STATE OF FLO QA ,,//����, //
COUNTY OF T1� YX-,_ Ace,ac C( COUNTY OF .'P'M/P /I`"&I �t
The paday
ing instr ent was
this of # rn
e
ackn
before me
ELIZABETH J. ANCEVSKI
0Y COMMISSION # EE086124
n W)RES: May 30, 2015
Notary PubW9f State of Florida )
P ally Known r OR Produced Identification
Type of Identification Produced 19 L% ) 9,5 In _9
Commission No.C—L'yB,61Z Z1 (Seal) -
Revised 07/15/2014
The for Qing ins try ent was
this m' ifay of PiPly
Notary
before me
ELIZABETH J. ANCEVSKI
MY COMMISSION # EE086124
EXPIRES: May 30, 2015
of Florida )
!�Oy Known OR Produced Identification
of Identification Produced
Commission No. 6�-'Og 6 12L/ (Seal)
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