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All APPLICABLE:;INFO MUST BE COMPLETED FOR APPLICATION.TO BE ACCEPTED ry m 1 1 -
Date::._� Permit;Number. '; 1 V�l� DuD
Building Permit Application
Planning and-Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:'(7.72)4.62-1578 COCiImer a� ReSltie[1tIaI ��x
FERIVI(TTYPE: <=arn,ILI le,-s,v(e-;-► _�G�
PROPOSED INIPROVEMENT•LOCATION _
Address:
Property Tax ID#: f.C) - .,�� ���4p�. ('(7' Lot No:
Site Plan Name: �flub. Block No.
Project Name' U P_Aj ,.�1"G : c ��i-f m_,5;& It ,i
DETAfILIrD DESCRIPTION OF 1NORIC
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, cr tf'Fn� c f�K �.�it..a•,{'° � `2 rr i $ x 3,"��'�.. " 3 .
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Additional work to be performed underthis permit-check all that apply;.'
(Mechanical _Gas Tank" Gas Piping g �Shutfers V Windows Doors
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�EPectric. `Plumbing _Sprinklers _ Generator � Roof ��th Pitch
Total Sq. Ft of Construction:_ Sq. Ft.of First Floor:
Cost of Construction:$_ f
1.3 j�fQ Utilities: _Sewer -Septic. Building Height: f
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Name. Ihct_v gC__-r 0rL11lna'ze`CC:_ 1 1-L. Name: C-4-1e.v\n
Address: _7.1 _� �51 S'4 Ae-eI�,` Fiji"?SIDI_ttttompany: Pn_}, [d���
City s .Cf .,r f✓ State: FtL Address:3:(,2 5 `S ` S t)P n y. 0) 6v'to p
Zip Code:L-? ! Fax: "77� f,`%%Z• ` i 5� City: :;_� ;� State: j
Phone No."7.7.) a 9 c� t/`� Zip Code:_' ((. Fax. 'I Tl- er qG )a,•'�i,,
E-Mail: r !-:o.Qn,� ic: r�, �. 73 C;,. 'I Phone C; � ,� ,n vta:.
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Fill in fee simple Title Holder on next page if different E-Mail •tn t)�1 . tjz�-�� ��
from the.Owner listed above), State or County License el:
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.
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SUPPLEMENTAL CONSTRl1CTlQN Ll��1 LAWN ;QRlv1ATlON:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY; _Not Applicable
Name: _ Name:
Address: Address:
City: State- City, State,—
Zip: Phone Zip: Phone.
FEE SIMPLE TITTLE 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 Countyy makes noreprese tation 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 Associatlon 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
commencing work or recordingour Notice of Commencement.
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Signature of Ow er/Lessee/Contractor as Agent for Owner Signature of Contractor/License Ho der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF. . ( c ei COUNTYOF :3 l c a C' f`P—
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this. i(a day of CY—T ,20 by this i�day of t=! 2Q y
/S A 1-n f d* C_r lac?rl rt A .tom;Itzj7
Name of:perso caking 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 Puybi State ofFMI lAd ,$RoVVE (Signature of Notary Public-State of lorida}
_°` "'8``b Commissi n#GG 104656 -o- Puk RHOND S ROWB
Commission No. * i�g 20Z1 Commission No. a°a; ° Cornmi �G 104656
., Ex4ira
Nj9TF6F f-p4 flended Thv Bu34ttnatary��rvkes Expires may 19,2021
yTEaF•F�°2``'T eordMtMuau�pt�NatcryServ�s
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE `
COMPLETED
Rev.8/2/17