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All APPLICABLE INFO MUST BE COM ED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: J WS'3
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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)4,62-1578 Commercial Residential _
PERMIT APPLICATION FOR:-�vin (2_� -QrD4 erT4YLj Cjumnc
19 R®'P�SED IINPR'QVEMENT L®CATIO'N:
Address: O ,'_EfAian 1tivQ,w �jrC_.r EOvr-�- 7trn-G2
Legal Description:';) '2 N l0 U �� 6 S I D 0 S I � .�1 ccze� or N
602_65 of RACT c,tJ A 2 Tights�C�2L�19- IR34) i
Property Tax ID#: 3S6-1 - 3-2Z - (7�167Z- C�(l� " ., Lot No.
Site Plan Name: -7 L!A_ S, 7 ,m I'a n i vt l- J7r, Block No. ;I
_ Project Name: ErrTru Cd umll_
Setbacks Front " Back: Right Side: Left Side: �IL:3
WE )LED D'k�SCRIPT ON O 'RaK:
C a N c,,ict f'-urn <vi e N Er,, r a 10 yy\N s �
j
I
UCTION I IiNI.O'RMATI0,
Additional work to be pertormed under this permit-check all tat 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: $ O° Utilities: —Sewer —Septic Building Height: 'I
0 LSSE; CONT ACTOR:
Name S r brrci ld: c=a�± U-C Name7_-2 'P.'rtr" �-
Address: ft 10 T1 -'Jbp" lz�g_ g' Company:�[
City: ;-,sour',ur i C� +�, State: Tk Address: r)�n Z S , Ft�1z� 1 ':I�yJ S4P. �Zal
Zip Code: Fax: City:�i irk S LuC, State: F'(.
Phone No. 5 6 Z`L.`n' 'Q 31 Zip Code: .219 5Z Fax:
E-Mail: Phone No SIPI• Z4?,- R931
Fill in fee simple Title Holder on next page (if different E-Mail Cj Lk-AQ01 ConS-hru[_-;Din. Cc)
from the Owner listed above) State or County License
i
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUC I N LIIEN 1ON:
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:
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 ' st inspection. I ou intend to obtain financing, consult with lender or an attorney before
comme s' f or recor i gyAur Notice of Commenceme .
Signatur of Ow er/Less ee/C ac Agent for Owner Signature of Contractor/License Ho der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFF COUNTY OFc, r', f�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this A day of R�-, 120^n by this_a�_day of -�74 ,20_D by
(Name of person acknowledging) (Name of person acknowledging)
na re of Notary Public- ate of Florida ) (Signs of Notary Public-State Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced -
��� Ihl ,�, ,,,���" LASHAHNA INGRAh4 t LASHAHNA INGRANI r>
sra�r�e�,� Y'j�"
�� ;_�„ „� Notar����P �+is-State of Florida �• n B'�., No(�����lic-State of Florida
ommission No. hqy Commgxpires Dec 2o,2018 Commission No. �i °�;—��
• , ,\l fi._NIy Comm.Expires Dec 20,201
p= commission #FF 177249aQ Commission# FF 177249
oF o As .,
Bon e
REVIEWS FRO NNING SUPERVISOR PLANS VEGETATION , LE MANGROVE
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