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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: ��-o� /� Permit Number: 1
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
23W 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 tine
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PRO.POSED IMPROVEMENT LOCATION:
Address: 35� 60AIR15k PLO.
Legal Description:_ C� `GATT '$ 614 9A 35 Nd
Property Tax ID#: 1tl2S ` 701 - 0614 - 060 - 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
4,o6TA k a�OT94k e6oklA)6 J. hFAJ)v(. 9Y61 /h WITH AA41 D cTujhA-k
TOIJ 1q.0 6RA M-1111 ' BEAT
=W,onal
STRUCTION INFORMATION:
work Wbe_rbsrtormed under this permit—c eckall apply:
CJWVAC Gas Tank FIGas Piping _Shutters i1 Vindows;Doors
U Electric Plumbing 05prinklers Generator. 011oof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor: j y
Cost of Construction:$ lv 000, _ Utilities:LJ SewerSeptic Building Height:
OWNER/LESSEE: CONTRA
Name TU VDR Nof VA TW Name•
Address: a521 5 4 4,a l S i_ &V A. Company:
City: ART PO4E State: Address: r'9,�'3
Zip Code: ` 9 it Fax: City: rl, e; a State:.
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Phone No._ Zip Code: / Fax:
E-Mail: Phone
Fill in fee simple Title Molder on next page(if different E-Mail:
from the Owner listed above) State or County License:4 0il-fo=_:j
ff value of construction is$2500 or more,a RECORDED Notice of Commencement is required,
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SU PPI.EI�IEI 4T' CONSTRUCTION LIEN LAUV INFORMATION:
:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not 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 an attorney before
commencing work or recording our Notice of Commencement.
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Signature of Owner/Leskd/lContraRtor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID > -
COUNTY OF R Ara e-. COUNTY OF . �.02 e.
The for a' g instrument was acknowledged before me The for of g instrument was acknowledged before me
;�this A%y of A. . 20 i1by thisR y of Feb. 20 /'�_by
/reyo orya anda akn
(Name of p rson acknowledging (Name of p rson acknowledgin
C1.c0 G�� L%��- Q/LOaYI-�
(Si ature of Notary Public-State of Florida) (Si ture of Notary Public-State of Florida)
Personal) Known OR Produc ifi tion Personally Known OR Produced Identification
Type of Identification Produced �+� I� 03 q'd7 lk -qType of Identification Produced
Commission No. /�_00793S__ (g I Commission No.do7g3 (Seal)
aot KRISTfINA R.PARSONS S 9ARISTINA K.PARSONS
NOTARY PUBLIC NOTARY PUBLIC
STATE OF FLORIDA OF FLORIDA
Revised 07/15/2014 . Comm#FF007935 . Comm#FF007935
19� Expires 4/23/2017 0 9�o Expires 4/23/2017
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REV W REVIEW REVIEW REVIEW
DATE .3
COMPLETE
INITIALS