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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �7 J
Date: c . • 0- 1-7 Permif Number:
71
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Building Permit Application FEB /9 2017
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Pi one: (772)462-1553 Fax: (772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR: '
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PROPOSED Il�l`PRO'� L
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Address: LA
Legal Description:
Property Tax ID#: LA ke Wit oo d GL e-'' 14 1)if - Lk- 40 bQ15 le t 7 Lot No. Jja -7
Site Plan Name: ff''n, Block No.
Project Name: LA KX W!)b d 61WIL
Setbacks Front Back: , Right Side:_ �" Left Side:
DES I�LE�D DE�SCRI`Pl'ION`
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CONST,RUCTI(JN L ` ORI�/IATION:.
itiona work to be performed under!his permit-check all that apply:
_Mechanical _Gas Tank = _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq:Ft.of First Floor:
Cost of Construction:$ 006, 01) Utilities: —Sewer —Septic Building Height:
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ame S Name:
Address: Company:
City: State:1EX, Address:
Zip Code: % Fax: City: State:
Phone No. -7 12 - 15 Zip Code: Fax:
E-Mail: lit Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S ,RP11EMENTAL CON51'RUCTtO'N LfEN LAW I°NFO'R+MATION.:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: 'John ari,n.P,lli 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:
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
commencing work or recording our Notice of.Commencement.
Signature of Owner/Lessee/ContractoJ7b
Signature of Contractor/License Holder
STATE OF FLORID,! ? r, STATE OF FLORIDA
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COUNTY OF '' COUNTY OF
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The Wing instrume was acknowle ' X a The forgoing instrument was acknowledged before me
this day of this day of 20_ by
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(Name of person acknowledging) a o (Name of person acknowledging)
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(Signature of Vary Public-State of Flor a ) (Signature of Notary Public-State of Florida)
Personally Know OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identi icati Type of Identification
Produced Produced
Commission No. 0 (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE , 11
RECEIVED 2
DATE r
COMPLETED
Rev. 7/2014