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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��/• / � Permit Number:
SAM=
Building Permit Application
JUL 10 2M7
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:
S ;R -� -
Address: Tygegi–liv
Legal Description:L
Property Tax ID#: 0� –b� S '` �� d Lot No.
Site Plan Name: Block No.
Project Name: e �c
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
/_
"Itional work to be performed under this permit–check all that appy:
_Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors
Electric — Plumbing _Sprinklers —Generator Roof ZS/Z Pitch
Total Sq. Ft of Construction: � Sq. Ft. of First Floor:
Cost of Construction: $ X',S CEOs Utilities: Sewer Septic Building Height: S
Name C Name:
Address: Company:
City: / State:_ Address:" SOV l y ; vL 2��y
Zip Code: !� Fax: r� City: vT2 State:
Phone No. '7 7 �' ;� / � L9 U O Zip Code: J S Faax:s /
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail �/1U /V�G� f�/ f���<<
from the Owner listed above) State or Co6ntq license S`�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEE : _ Not Applicable MORTGAGE COMPANY: _ of Applicable
Name: ( (A �, Name:
Address: v S OEP Address:
City: /rN State: YI City: State:
Zip: Phone .� 7 5�4Zip: Phone: 7 11
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: ZZNot 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencin k or, recgrrding your Notice of Commencement.
Si ure
i Owner/Lessee/Contractor as Agent for Owner Signatu f Contractor/License Holder _
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2 WA OF FLORIDA _ STATE OF FLORIDA
TY OF COUNTY OF I -�-N
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oing instrument was acknowledged before me The for oing instrument was acknowledged befo
se day of cam& 201�iy this��day of v 20 by >-23&j Z
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f person acknowledging) (Name of person acknowledging) "' "r •.
ignature of 497ary Public-State of Florida) (Signature of Not blic-State of Florida )
Personally Known OR Produced Identification✓ Personally Known OR Produced Identification
Type of Identification Type of Identific ' n
Produced Produced - h
Commission No. (Seal) Commission N4) (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED 0
DATE ]
COMPLETED J
Re—v-.7/2014