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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: o� ! ) Permit Number:11
RECEP.7D FEB 162917
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Legal Description:
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Property Tax ID#: 3� v� ;�_oO Cs9 Lot No.
Site Plan Name: ,/gyp Block No.
Project Name: S a O� ►� �- r \ert�.,--ag �� �5'
Setbacks Front 20. 0 r Back: QL Right Side: a4, (a a Left Side:
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itiona wor to e e orme un er t is permit-c ec a app y:
�HVAC �Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: �`� S . Ft.of First Floor: � ( U
Cost of Construction:$ _` S� Utilities:Sewer tZN Septic Building Height:
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f�CONTRACTOR �
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Name Name:
Address: An Company:- ylt"c_a a_ Ids
City
: � _P b�a�. _ State:��- Address: 1� �� l� , �,b.S C S d&
Zip Code: 3 c)-9 G I Fax: &dL 7 ar S r?0.3 City: State: ic(_
Phone No. 3,� 7 cl)_Ys_�9 y Zip Code: 3d-ci O ► Fax:
E-Mail: IC�°cC�er\i� r 1 ("�n,Gr-�-d�_ Cx>,� Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: l0.<Fc�y�, j ✓ cam . ,�nA
from the Owner listed above) State or County License: CG C 1 a 3 ) S-3'
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. o@L 51a�
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: lot Applicable
Name: FP --v nS_z Name:
Address: <Dog , r1 Address:
City: State: F L City: State:
Zip: "D,-) -) I Phone: 141 -)�) b Ltq I Zip: Phone:
FEE SIMPLE TITLE HOLDER: 4_6 Not Applicable BONDING COMPANY: 71!fNot Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 a attorney before
commencingwor recording
r rordin our Notice of Commencement. /f
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_Signatur of Owner essee/Agent Signature of Contractor/Licens older
STATE OF FLOIDA STATE OF FLORIDA
COUNTY OF o r-_�-J0. COUNTY OF
The forgoing instrVmept was acknowledged before me The forgoing instrument was acknowledged before me
this L 3 day of 20 U by this_0 day of _Dby
(Name of person acknowledgin (Name of person acknowledging)
(Signatur otary Publi ate of id (Si Public-Sta Florida)
ersonally Known OR Pro FRt( Personal n �R Produced Identification
Type of Identific uc� IE Type of Identific n,p& uce
;£ " O�Iu11SS1 _�` " ARIE LAFRENIERE
0N#E
Commission No. =••�Y `c MY C ES A)05, "20�7 Commission No. - ' '= MY COMMISS� )EE881
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'••,►r�o�;;;•,�53 Piondar �m '•.,w� ,,�`' EXPIRES Ma
aw rCh 05,2017
(407)3B&0153
m
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REV EW REVIEW REVIEW REVIEW
DATE +�
COMPLETE
INITIALS