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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: lC ss 2-0 Permit Number:
•
Building Permit Application
Planning and Development Services _
Building and Code Regulption 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
Address: (000
r
Legal Description: S u-^�kCl
Property Tax ID #: 33 ri02.- (ot O - 052'4 - 000 S Lot No. 28
Site Plan Name: Block No. 97
Project Name-
Setbacks Front
Back:
Right Side:
Left Side:
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.,sst,.. G).A . s
r� �
tttona wor to
e e orme un
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ert tsperm2-c eckallt
atapp�y.
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❑_ HVAC
Gas Tank
❑Gas Piping
Shutters Windows/Doors
❑Electric
� Plumbing
�Sprinkiers
�
Generator � Roof � Roof pitch
Total Sq. Ft of Construction: 5 Ft. of First Floor:
Cost of Construction:.$ a{ 75s uti!i ies:11Sewer r I Septic Building Height:
Name
Address: (Poog z3dtsd�- r
Gty State:�-
Zi:Code-
-7
Fax
Phone No.17 2-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
If value of construction is $2500 or:more, a RECORDED Notice
Name: Pet=_rACafaro fit
Company: Lowes Nome Centers;)_LC
Address: P.O.Box 781993"
Citv: Orlando State: FL
Zip Code: 32878-1993 Fax:
Phone No. 112 k[t3- 3fo4 S'
E-Mail:
State or County License: CGC150841
Commencement is required.
Name:......,
Address'
Citys State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name: _
Address:
City:
Zip:
COMPANY: � Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Applicable I BONDING COMPANY:
Name: _
Address:
Zip: Phone:
Applicable
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countfly makes no representation that is granting a permit will authorize the permit holder to build the subject structure
swhich is in co tructure. Please consult with th any your Hlome OwnOwners erss Association andrreviewyyour deed for any restrictio s nts that which may arestrict orpply. bit such
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 ma esult in your paying twice for
improvements to your property. A Notice of Commencement must be r ord d and po d on the jobsite
before the first inspection u intend to obtain financing, consult wi len r or alto ney before
rnmmpncine work or reg6rdinfiyour Notice of Commencement
STATE OF
COUNTY I
was acknowledged before me
;! 20-U—by
Peter a Cafam Iili�
(Name of person
Personally.
Type oflde
Commission No.
Revised 07/15/2014
OR Produced Identification
Notary I
Kan M
STATE
The forgoi�g)nstrument was acknowledged before me
thi� day off , 20 tO by
Peter A Cairo III
(Name of person,acknowledging )
Personally Known x
Type of Identification
Commission No.
OR Produced Identification
FF 981647
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