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All APPLICABLE INFO MUST BE COM TED FOR APPLICATION TO BE ACCEPTED
Date: 12' 20 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 _ )<,e y,.
PERMITTYPE:
FFiO.POSED.fiVIPROUEMENT,LOCAT10f1
t�
Address:
Property Tax ID#: f - a - - On 9 - 006` 7 Lot No.
Site Plan Name: � '�I-rn 'f*Z l'= E L-- J�: Block No.
Project Name: 111 e; ni cy,l z. rtl ris, it
°DETAI'L=ED DESCRIPTIO 0F:INORK I
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Additional work to be performed under this permit-check all that apply:
Mechanical —Gas Tank _Gas Piping V Shutters v"-Windows/Doors
'ZElectric V'Plumbing _Sprinklers _Generator '`� Roof 6kL Pitch
Total 5q. Ft of Construction: / oC_._- Sq. Ft.of First Floor:
Cost of Construction:$ 7 _ Utilities: ._,Sewer 4 Septic Building Height: 1 j
011UNft�LSSE r 1 � � r_: CO:NIRACTOR� t
Name i nn e�r c tin, Q� 0,�6� �,��c:ci�. rName: C-A r\ A-Ok-y%
Address: "7_2 f A eS Et.s.L AL rah;�f�lrrd ti ,a.�_f"Company: ��n�k�� E'�,�}�Ci c.°Cs
City: lk ka-tJI " ;e State: ; Address:17,.-:_5 c'' 0 ozjan
Zip I Code:--?-4 d f Fax: -:17,2 f,` <. ` 1'STf City: I�{� � ,`s State: I-1
j' e , U Zi Code:• r '[�
Phone No. r 7,.') ,�� J::�• 'fin r�f� p Z..�4- J f � Fax: '�l.�
E-Mail: Phone Na
Fill in fee simple Title Holder on next page(if different E-Mailtr
from the Owner listed above) State or County License e-"`j3t'
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPlE(VI IVT,gL:GONSfiRUCTIQN LIEN LAW I�FORIvATiON.
,.. .... .
DESIGNER/ENGINEER; Not Applicable MORTGAGE,COMPANY: _Not Applicable
'Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER r 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 make no represent tion that is granting a permit will authorize the permit holder to build the subject structure
w�ilch is in conflict wit 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 1 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 tender or an attorney before
com mencinR work or recordin our Notice of Commencement.
� . ..; L
Signat ssee/Contractor as Agent for owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF `� t_ c�C 1
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged,before me
this It,. day of CX T 20 Oby this I(o day of Q CA 2dL uby
Name of persop'fnaking statement Name of person making statement
Personally Known ✓✓'' OR Produced Identification Personally Known. OR Produced Identification
Type of identification Type of Identification
Produced Produced
(Signature of Notary Pu�ibrU State bfft¢a$P.OWE (Signature of Notary public-State of larida)
R14ONDAS ROWE
commiss� r#GG 14dfi56 q�4Y a�&�
Commission No. r Explresi�c 2421 Commission No. Ccmmis lPG i04666
N'`7FF y^�'Q 6ondad'r�N9uApelNetary5c 9ius �a 1ixpUss May 19,2421
OF FI - �rFOF F�pQ\ EsanExpl"uBudgal4OWry Sarvkac
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
'RECEiVED
:DATE
COMPLETED
Rev,8/2117