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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVES
' JAN j S ?92,
Building Permit Applicatirmlttingpe
Planning and Development Services St. Lucie Countmeryt
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: DULCA,
PR • P05ED MP O ENT LOCATION:
Address: Lrn n1 M C-e a
�syi-RR
Property Tax ID #: �i ,� f / JS / V� UV / Lot No.
Site Plan Name: Block No.
Project Name:
ETA6 �D DE-�5CRIP ION Ck.F �R .
eZ e %ZCAte +5-TOi1-125 04 714!L 0 �06L's
(3k:1.
ceM ,cede .47Ti46(,eo� ;a/_.4w
ON 7RUCTION ! O MAT( N:
Additional work to be performed under this 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 Constetlon: = 45-1. . I 64 G' Utilities: Sewer - Septic Building Height:
OWNERf LES- EE:
CON ACTOR:
0-R "4,LPj P-�,"slerQ
Name:
me
L.Address: 167 0 1 So 6eeAw ikiy c tole j
Company
City: —1 t=+ysoy AeytA State: F
Address':
City: State:
l;Zip Code- .3,gt7$77 Fax:
s[Phone No. 3d3 — ! I —�' bl �O
Zip Code: Fax:
d'
E-Mail: ��� V i e, -e bt�l SS/tl � G'&wi
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
om the Owner listed above)
State or County License
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.
WROILORM C7'
DESIGN ER/ENGINER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:_ � E� . AJ LL it
Name:
Address: S . W .
Address:
City: Per S ,.. L-" ,e State: FL,_
City: State:
Zip: ,T-4f qk7 Phone .�" f - G q 7 S
Zip: Phone:
FEE SIMPLE TITLE HOLDER: )k 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT.
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
+ture
11 of Owner/ Lessee/Co ctor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA Q
COUNTY
STATE OF FLORIDA
OF
COUNTY OF
The for ping instru wa
s as ac owledged before me
AA
The forgoing instrument was acknowledged before me
this aoy of 20 by
this day of 20_ by
U ion.�Sk'
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification -�
Type of Identification
Produced 0 n 1�
Produced
I
(Signature of Notary PubTic- Stat—elbf Florida)
(Signature of Notary Public- State of Florida )
Commission No. II.„ ELL(.INAUGHN
Commission No. (Seal)
_State of Florida -Notary Public
_* * Commission # GG 270079
i ,FOI11 Off`
y commiEsion
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