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ALL APPLICABLE INFO MUST;BE COMPLETED FOR APPLICATION TO BE ACCEPTED ]
Date: Permit Number: '`® i i
•
RECEIVED
Building Permit Application
Planning and Development Services APR 1 i" 2017
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ,. Inty,
' FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentfl L'� ��''
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT OCATION;: /
Address: 6 (f'l'
Legal Description: Tff nuA QW
Property Tax ID#: V ll Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to bg_grormed under this permit—check all apply:
11HVAC _Gas!Tank ❑Gas Piping _Shutters ❑Windows/Doors
FlElectric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ J CA Q 15, Utilities: _Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name &nnY allt Name: tr, Loa _
Address: ` 'L , >f 1klc Company: v2 Rv S
City: �� l State:_ Address: �l�( V�C• t�
Zip Code: Fax: City: kl State___PT__
Phone No. Zip Code: Fax
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: 5441
i
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
,-SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
III 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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Signat re of ner/Lessee/Contractor as Agent for Owner Sig a ure of tontrg6Kr/Gcense older
STATE OF FLORIDASTATE OF FLORIIp4i,
COUNTY OF �oQC,�'� COUNTY OF ..mall
The fo going instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 1by this_Lt_day of A-DY'6 20 t] by
(Name o ?rson acknowledging) (Name of pe n acknowledging)
ICI, r f la
(Signature of Notary Public-State otoorida) (Signature of Notary Public-State of Florida)
PersonallyKnown OR Produced Identification Personally KnownXProdu0cedP
Rroduced Identification
Y
Type of Identific tion Produced Type of Identificat
Commission No. (Seal) Commis o.
q41—' +4 Notary Public State of Florida
ida �' Antonia h1 Paula
ti mmiss""FF 191201
k� ° Antonia iJI Paula �ofs�.0 Expires 02/27/2019
Revised 07/15/201 My ccmmission FF 191201
e � o Expires 02I27/2019 /
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DATE
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INITIALS
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