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- ALL APPLICABIE INF MUST BE COMPLETED FOR AP LIGATION TO BE ACCEPTEb
Date: Permit Number.
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Building Permit Appli on
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
- :-;PRQPOSEp�IMPROUEMENT'lOCATION � ;. �`' � ` 4 ,3 � _ -L
Address: v� �• "
Legal Description: 1�. V� - "C� L � 1—O� �`
RECEIVED
Property Tax ID#: S t l —R l 5,—a on LA Lot No.
Site Plan-Name: MAR 21 1017 Block No.
f� ENVIRONMENTAL
Project Name: LV4�-r- S 1 t �3
Setbacks Front Back: Right Side: Left Side: "
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CO1u5TRUCTION�INFOR 10N z �$ 3
Additional worK to e e orme under this permit—c ec a apply:
11HVAC EGas Tank , Gas Piping El_Shutters Q Windows/Doors .
Electric 0 Plumbing ❑,Sprinklers Generator 0-Roof", Roof pitch
0
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction: Utilities. Sewer 0 Septic Building Height:
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Name
Address: Company: tits
City: �Yfr��' edrC tk State: Address: L i Ste..
Zip Code: :3 q2i Fax:' City: 7 S L_� State:
Phone No. 1) Tq Zip Code:- 3`0,12— Fax:
E-Mail: Phone No. '711_ ^�z"ZtJ
Fill in fee simple Title Holder on next page(if different E-Mail:" yy
from the Owner listed above) State or County License:
,If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
�I�PPLEMENTA CONSTRUCTION LIEN,LAW�i�1F011/IATION _
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DESI(3NER/ENGINEER: Not Applicable MORTGAGE COMPANY: —Not Applicable
Name: D'U,L_ Name:
Address: w t Address:
City: L_� State: F=J _ City: State:
Zip: Phone: `i'i), 7AIT-qPIR10 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 reco ur otce of Commencement.
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Signature of O er s76ntractgr as Agent for Owner Signature of r r ' e e Holder
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STATE LORIDA C 1 �` STATE O ORIDA
COUNTY OF �' COON OF
The ing mstrurreipt was owled8� before me Th g instrum nt was ack owledge before me
this day of �--1� , 2�1 by this dayof 20 �by
sc'�D�± . sz':� C, 421�± S�-(tct
(Name of person acknowled ' ) f(Name of person ackno ledging)
(Signature blic=Sta f Florida) S ry Public-State of Flo ida)
onally Known OR Produced Identification Personally Known OR Produced Identification
Type of Idn ro Type of Identificat'.n Produced
`4PaY Plj�ram• \
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Notar Public-State o€€lor'da Commission No �a'• AN
Comm issio- _ ymission#FF 2�d a <� GELA
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My Comm.'Explres May 27,2019 rq a ° Commission °I
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'< RnodPdJhW,igh Not-pal '••.°�d my omm.Expires MaY 27,
-- �„ Bonded through National No tar 2019
Revised 07/15/2014 B YAssn.R
REVIEWS FRONT ZONING SUPERVISOR .PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIE,W� REVIEW/ EVIEW REVIEW
DATE
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COMPLETE
INITIALS