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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: dDI-0• ()13q
- - 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
IPERMIT APPLICATION FOR: ��v/M����,✓�J J
Address:
Legal Description:
Property Tax ID #:2,32.6 'LSD 1- /1 LS lo• �� �� ' Z Lot No.
Site Plan Name: _ Block No. /
Project Na
Setbacks
Side/4Q/ LeftSide;2YY
_Mechanical _ Gas -Tank _ Gas Piping _ Shutters _ Windows/Doors
.11"llectric N,,.Mlumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ ( 6 6 ,
Generator Roof
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Name Z—
Addres • D
City: I Statej�
Zip Code: Fax:
Phone No l f
9, E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: AtOlOr'—K=/ k .C�VU�`1ti
Company: Z 0
Address: %
City: l�'T A i e e6 (f— Stater
Zip Code:— `�9.92 Fax: IL 6 :5 "/ 0 45 3
Phone No d
E-Mail D d c
State or County License
\ If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESI /EN
INEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:`
Address:
1 a ttQ
W Cgr e4
Address:
City:
Qy'
Stater
City: State:
Zip:
Phone
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not 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
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Signature of O ner/ Agent/ ss Contractor
Signature o ontractor/License Holder
STATE OF FLORIO L Z
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STATE OF FLORI LLZZ-4
COUNTY OF "`` �`
COUNTY OF �T
The oIng inst ent s cknowledged before me
The f r oing instr nt w s ac (nowledgp�i before me
this � day of 20 Z&V
this � day of 20� by
se_9�
r �✓
r(N7:peson a c k 1ledging)
(N person owledging )
Sig atur of Notary Publi State of Florida)
)
(i n ture of Nota Public- State of FloridaC_
Personally Known �+ OR Produced Identification
ersona nown OR Produced Identification
_
Type of Identification
Produced ,Yaue��c SHERRI FEHLMAN
Type of Identi ica on
produced SHERRI FEHLMAN
_ Commission # GG 18716
* *
Expires March 14, 2022
=at; • .s�,c
ftipm�f��ssion # GG 187160
Commission No. * * ( ff March 14, 2022
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